Healthcare Provider Details

I. General information

NPI: 1164518304
Provider Name (Legal Business Name): REBECCA ESTHER MERRITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ESTHER WOLLMANN M.D.

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N WALL ST
SPOKANE WA
99201-0812
US

IV. Provider business mailing address

499 W. WASHINGTON AVE #1197
AVA MO
65608
US

V. Phone/Fax

Practice location:
  • Phone: 206-910-9476
  • Fax:
Mailing address:
  • Phone: 417-686-1310
  • Fax: 816-922-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2000167872
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: