Healthcare Provider Details

I. General information

NPI: 1619293206
Provider Name (Legal Business Name): REBECCA HASTINGS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA HASTINGS

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S MAIN ST STE 1
OTTAWA KS
66067-3544
US

IV. Provider business mailing address

1418 S MAIN ST STE 1
OTTAWA KS
66067-3544
US

V. Phone/Fax

Practice location:
  • Phone: 785-229-3530
  • Fax: 785-229-3529
Mailing address:
  • Phone: 785-229-3530
  • Fax: 785-229-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number13-67385-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: