Provider Demographics
NPI:1073842506
Name:THURN, REBECCA (BECKY) GRACE (APN,C)
Entity Type:Individual
Prefix:
First Name:REBECCA (BECKY)
Middle Name:GRACE
Last Name:THURN
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:REBECCA (BECKY)
Other - Middle Name:GRACE
Other - Last Name:THORSON (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-4785
Mailing Address - Fax:551-996-5697
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304993363LA2200X
NJ26NJ00136500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health