Basic Information
| Provider Information | |||||||||
| NPI: | 1164759379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRK-EWING | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 137 | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835220137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089523251 | ||||||||
| FaxNumber: | 2089622323 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 LEWISTON ST | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835229750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089623251 | ||||||||
| FaxNumber: | 2089622323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2009 | ||||||||
| LastUpdateDate: | 11/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 2031-0119 | ID | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.