MEDICARE: MRS. REBECCA SUE WAMPLER

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1790037901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA SUE WAMPLER

Provider Business Mailing Address
First Line	:	305 E NORTH ST
Second Line	:
City	:	BOURBON
State	:	IN
Zip	:	46504-1614
Country	:	US
Telephone Number	:	574-342-0431
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 E. NORTH ST
Second Line	:
City	:	BOURBON
State	:	IN
Zip	:	46504-1416
Country	:	US
Telephone Number	:	574-342-0431
Fax Number	:

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

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	10/11/2012

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