Healthcare Provider Details

I. General information

NPI: 1629453576
Provider Name (Legal Business Name): REBECCA MACKENZIE MOATES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA SCHERER

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 NUNNER RD
MAINEVILLE OH
45039-9632
US

IV. Provider business mailing address

67 NUNNER RD
MAINEVILLE OH
45039-9632
US

V. Phone/Fax

Practice location:
  • Phone: 513-677-2405
  • Fax: 513-677-2781
Mailing address:
  • Phone: 513-677-2405
  • Fax: 513-677-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17538-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: