Provider Demographics
NPI:1629453576
Name:MOATES, REBECCA MACKENZIE (FNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MACKENZIE
Last Name:MOATES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SCHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67 NUNNER RD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9632
Mailing Address - Country:US
Mailing Address - Phone:513-677-2405
Mailing Address - Fax:513-677-2781
Practice Address - Street 1:67 NUNNER RD
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9632
Practice Address - Country:US
Practice Address - Phone:513-677-2405
Practice Address - Fax:513-677-2781
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17538-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily