Provider Demographics
NPI:1396348942
Name:KRIGBAUM, REBECCA D
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:KRIGBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITHOPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:43136-9774
Mailing Address - Country:US
Mailing Address - Phone:614-738-4168
Mailing Address - Fax:
Practice Address - Street 1:653 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:LITHOPOLIS
Practice Address - State:OH
Practice Address - Zip Code:43136-9774
Practice Address - Country:US
Practice Address - Phone:614-738-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2305213376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker