Doctor Name: | MRS. REBA JEAN MAHAFFEY |
NPI Number: | 1215072715 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN MS FNP |
License Number: | 71001207A |
Business Practice Address: | 123 S Mckinley Ave Rensselaer, IN - 479782949 |
Business Phone Number: | 2198667222 |
Business Fax Number: | 2198667001 |
Mailing Address: | 123 S Mckinley Ave, RENSSELAER |
State: | IN |
Postal Code: | 479782949 |
Phone Number: | 2198667222 |
Fax Number: | 2198667001 |
NPI Enumeration Date: | 02/21/2007 |
NPI Last Update Date: | 12/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71001207A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |