Rebekah Marlene Connelly, LD
Individual provider Active NPI Denturist · Warrenton, OR
NPI 1902625841 · NPPES record last updated Oct 8, 2024
Key facts
- NPI
- 1902625841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Denturist 122400000X
- License
- DT-TMP-10248215 (OR)
- Practice address
- 65 N Highway 101
Warrenton, OR 97146-9371 - Phone
- (503) 861-8624
- Fax
- (503) 861-8625
- NPI assigned
- Oct 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-TMP-10248215 | OR | MD | Denturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | DT-TMP-10248215 | OR | Yes |
Addresses
Primary practice location
65 N Highway 101
Warrenton, OR 97146-9371
Mailing address
65 N Highway 101
Warrenton, OR 97146-9371
Phone (503) 861-8624
Other providers in Warrenton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.