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General NPI Number Information
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NPI Number | 1639875032
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Entity Type | Individual
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Provider Name | REBECCA LOATWALL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 104 FORT HILL RD
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City | WAVERLY
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State | TN
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Zip | 37185-2128
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Country | US
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Telephone | 731-394-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 4263 BUDDS CREEK RD
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City | CUNNINGHAM
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State | TN
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Zip | 37052-4642
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Country | US
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Telephone | 931-553-3724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 33241
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License Number State | TN
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