Healthcare Provider Details

I. General information

NPI: 1336782176
Provider Name (Legal Business Name): REBEKAH ELIZABETH RICH SHIRRELL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GORDON GUTMANN BLVD # 210
JEFFERSONVILLE IN
47130-3764
US

IV. Provider business mailing address

301 GORDON GUTMANN BLVD STE 201
JEFFERSONVILLE IN
47130-3766
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-6114
  • Fax:
Mailing address:
  • Phone: 812-282-6114
  • Fax: 812-650-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number71009521A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000334A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: