MEDICARE: MRS. REBECCA S MOONEY CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R113007	MD

General Provider Information

NPI Number	:	1154323319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA S MOONEY CRNP

Provider Business Mailing Address
First Line	:	19 WALNUT LN
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2479
Country	:	US
Telephone Number	:	410-272-3233
Fax Number	:	410-273-9465

Provider Business Practice Location Address
First Line	:	19 WALNUT LN
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2479
Country	:	US
Telephone Number	:	410-272-3233
Fax Number	:	410-273-9465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/29/2010

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