Basic Information
| Provider Information | |||||||||
| NPI: | 1336782176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIRRELL | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | ELIZABETH RICH | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 GORDON GUTMANN BLVD STE 201 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122826114 | ||||||||
| FaxNumber: | 8126505315 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 GORDON GUTMANN BLVD # 210 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122826114 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2019 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 71009521A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 09000334A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 71009521A | 01 | IN | IN LICENSE | OTHER |