Healthcare Provider Details

I. General information

NPI: 1699236869
Provider Name (Legal Business Name): REBECCA NAN MCCAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 W MORENO AVE
COLORADO SPRINGS CO
80905-1731
US

IV. Provider business mailing address

4448 CANTEEN TRL
COLORADO SPRINGS CO
80922-2520
US

V. Phone/Fax

Practice location:
  • Phone: 719-510-4803
  • Fax:
Mailing address:
  • Phone: 719-510-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0129496
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: