Healthcare Provider Details

I. General information

NPI: 1730393950
Provider Name (Legal Business Name): REBEKAH LEIGH RUPPE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 W 168TH ST
NEW YORK NY
10032-3703
US

IV. Provider business mailing address

4746 40TH ST APT 2C
SUNNYSIDE NY
11104-4047
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6994
  • Fax: 212-305-6937
Mailing address:
  • Phone: 347-675-2072
  • Fax: 212-305-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001040
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: