Provider Demographics
NPI:1891511630
Name:MOCKELMAN, REBECCA MAY (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAY
Last Name:MOCKELMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MAY
Other - Last Name:KILPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3501 HARRY LANGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8644
Mailing Address - Country:US
Mailing Address - Phone:712-366-3252
Mailing Address - Fax:712-366-3225
Practice Address - Street 1:3501 HARRY LANGDON BLVD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-8644
Practice Address - Country:US
Practice Address - Phone:712-366-3252
Practice Address - Fax:712-366-3225
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA154527163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool