Healthcare Provider Details

I. General information

NPI: 1700883907
Provider Name (Legal Business Name): REBECCA A HONAKER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. REBECCA SANDERS

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5381
  • Fax: 740-446-5082
Mailing address:
  • Phone: 740-446-5381
  • Fax: 740-446-5082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10222
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number58257
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: