Healthcare Provider Details

I. General information

NPI: 1114587391
Provider Name (Legal Business Name): REBECCA INGALLS CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 PORTSMOUTH AVE
GREENLAND NH
03840-2251
US

IV. Provider business mailing address

559 PORTSMOUTH AVE
GREENLAND NH
03840-2251
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-7588
  • Fax:
Mailing address:
  • Phone: 603-436-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP241362
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number089379-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: