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NPI Code Detail

MEDICARE: REBECCA TARATUTA

MEDICARE:   REBECCA  TARATUTA
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
1363LF0000XFamily Nurse Practitioner2015034095MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2PENDINGOTHERMORR MCR

General Provider Information

NPI Number : 1760852347
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA TARATUTA
Provider Business Mailing Address
First Line : PO BOX 505164
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-5164
Country : US
Telephone Number : 417-829-4620
Fax Number :
Provider Business Practice Location Address
First Line : 940 W MOUNT VERNON ST
Second Line : STE 100
City : NIXA
State : MO
Zip : 65714-9618
Country : US
Telephone Number : 417-724-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2015
Last Update Date : 11/04/2015

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Directions to “ REBECCA TARATUTA ” Practice Location

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