MEDICARE: REBEKAH SUE MYRICK LM, CPM

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1588915607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH SUE MYRICK LM, CPM

Provider Business Mailing Address
First Line	:	6477 WATER WORKS RD
Second Line	:
City	:	MOUNT OLIVE
State	:	AL
Zip	:	35117-3506
Country	:	US
Telephone Number	:	205-234-8172
Fax Number	:	205-263-6480

Provider Business Practice Location Address
First Line	:	6477 WATER WORKS RD
Second Line	:
City	:	MOUNT OLIVE
State	:	AL
Zip	:	35117-3506
Country	:	US
Telephone Number	:	205-234-8172
Fax Number	:	205-263-6480

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	07/24/2020

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