Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1104589407 |
---|---|
Provider Name | Mrs. Rebekah Loney |
First Address | Wellston, OK 74881-6126 |
Second Address | Wellston, OK 74881-6126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2021 |
Last Update Date | 14/10/2021 |