Healthcare Provider Details

I. General information

NPI: 1245646934
Provider Name (Legal Business Name): REBECCA D. ZIEHR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

PO BOX 504274
SAINT LOUIS MO
63150-4274
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2115
  • Fax: 417-820-5344
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014021882
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: