Healthcare Provider Details

I. General information

NPI: 1023395431
Provider Name (Legal Business Name): REBECCA AYNE MOORE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 513-318-1188
  • Fax: 513-318-1189
Mailing address:
  • Phone: 317-963-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCOA12727NM
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000293A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: