Healthcare Provider Details

I. General information

NPI: 1336455708
Provider Name (Legal Business Name): REBECCA M HANKINS-FARBER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

IV. Provider business mailing address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-1120
  • Fax:
Mailing address:
  • Phone: 573-468-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149992
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010027591
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2010027591
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: