Healthcare Provider Details

I. General information

NPI: 1891511630
Provider Name (Legal Business Name): REBECCA MAY MOCKELMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MAY KILPATRICK RN

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HARRY LANGDON BLVD
COUNCIL BLUFFS IA
51503-8644
US

IV. Provider business mailing address

3501 HARRY LANGDON BLVD
COUNCIL BLUFFS IA
51503-8644
US

V. Phone/Fax

Practice location:
  • Phone: 712-366-3252
  • Fax: 712-366-3225
Mailing address:
  • Phone: 712-366-3252
  • Fax: 712-366-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberIA154527
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: