Provider Demographics
NPI:1245251420
Name:ULLMAN, REBECCA A (MIDWIFE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1105
Mailing Address - Country:US
Mailing Address - Phone:541-880-2770
Mailing Address - Fax:541-885-4649
Practice Address - Street 1:2630 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1105
Practice Address - Country:US
Practice Address - Phone:541-880-2770
Practice Address - Fax:541-885-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006846N5NMNP-PP176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR011705Medicare ID - Type Unspecified
116611Medicare ID - Type Unspecified
R49710Medicare UPIN