Provider Demographics
NPI:1073618054
Name:JONES, REBECCA K (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KATHERINE
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22264 WEBB ROAD
Mailing Address - Street 2:
Mailing Address - City:LAPWAI
Mailing Address - State:ID
Mailing Address - Zip Code:83540
Mailing Address - Country:US
Mailing Address - Phone:208-816-1605
Mailing Address - Fax:
Practice Address - Street 1:111 BEAVER GRADE
Practice Address - Street 2:NIMIIPUU
Practice Address - City:LAPWAI
Practice Address - State:ID
Practice Address - Zip Code:83540
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:208-843-7247
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN19577RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN19577OtherBOARD OF NURSING