MEDICARE: REBBY CHEPKORIR MUTAI

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	163W00000X	Registered Nurse	932528	TX

General Provider Information

NPI Number	:	1407318108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBBY CHEPKORIR MUTAI

Provider Business Mailing Address
First Line	:	7902 ROSWELL CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4800
Country	:	US
Telephone Number	:	704-258-5307
Fax Number	:

Provider Business Practice Location Address
First Line	:	7902 ROSWELL CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4800
Country	:	US
Telephone Number	:	704-258-5307
Fax Number	:

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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Directions to “ REBBY CHEPKORIR MUTAI ” Practice Location

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