Provider Demographics
NPI:1386937456
Name:ROMINE, REBECCA MARY (MED)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARY
Last Name:ROMINE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2493
Mailing Address - Street 2:
Mailing Address - City:BIRCH TREE
Mailing Address - State:MO
Mailing Address - Zip Code:65438-9229
Mailing Address - Country:US
Mailing Address - Phone:573-714-5276
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2493
Practice Address - Street 2:
Practice Address - City:BIRCH TREE
Practice Address - State:MO
Practice Address - Zip Code:65438-9229
Practice Address - Country:US
Practice Address - Phone:573-714-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist