Provider Demographics
NPI:1881584803
Name:ATIENO, REBECCA GRACE (MBCHB)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GRACE
Last Name:ATIENO
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 YELLOWLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-1473
Mailing Address - Country:US
Mailing Address - Phone:317-414-0442
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-446-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program