Provider Demographics
NPI:1730393950
Name:RUPPE, REBEKAH LEIGH (CNM)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:LEIGH
Last Name:RUPPE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 40TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4047
Mailing Address - Country:US
Mailing Address - Phone:347-675-2072
Mailing Address - Fax:212-305-6937
Practice Address - Street 1:617 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3703
Practice Address - Country:US
Practice Address - Phone:212-305-6994
Practice Address - Fax:212-305-6937
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001040367A00000X
NYF360466363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology