MEDICARE: REBECCA MCGOVERN RN

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	163WS0200X	School Registered Nurse	415204	OH

General Provider Information

NPI Number	:	1851764997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MCGOVERN RN

Provider Business Mailing Address
First Line	:	2706 HOLT RD
Second Line	:	HOLT CROSSING INTERMEDIATE SCHOOL
City	:	GROVE CITY
State	:	OH
Zip	:	43123-9688
Country	:	US
Telephone Number	:	614-801-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 HOLT RD
Second Line	:	HOLT CROSSING INTERMEDIATE SCHOOL
City	:	GROVE CITY
State	:	OH
Zip	:	43123-9688
Country	:	US
Telephone Number	:	614-801-8709
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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