Healthcare Provider Details

I. General information

NPI: 1821416702
Provider Name (Legal Business Name): REBECCA RAINE MUNRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

16 E 13TH ST
LAWRENCE KS
66044-3502
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-1029
  • Fax:
Mailing address:
  • Phone: 785-813-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-43667
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: