Healthcare Provider Details

I. General information

NPI: 1508236878
Provider Name (Legal Business Name): REBECCA CROFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 CHARLESTOWN RD
NEW ALBANY IN
47150-2560
US

IV. Provider business mailing address

400 GILMORE AVE
JEFFERSONVILLE IN
47130-4722
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-0235
  • Fax: 812-945-0778
Mailing address:
  • Phone: 812-945-0235
  • Fax: 812-945-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001370A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: