Healthcare Provider Details

I. General information

NPI: 1932726783
Provider Name (Legal Business Name): REBECCA MOORE CASTLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 SUNSET RD
CANTON PA
17724-7680
US

IV. Provider business mailing address

127 SULLIVAN ST
CANTON PA
17724-1733
US

V. Phone/Fax

Practice location:
  • Phone: 570-772-4438
  • Fax:
Mailing address:
  • Phone: 507-673-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN278498L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberSP023605
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: