Provider Demographics
NPI:1093034191
Name:EVANS, REBECKA MARIE (RN, NP)
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:REBECKA
Other - Middle Name:MARIE
Other - Last Name:MOWDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4802
Mailing Address - Country:US
Mailing Address - Phone:617-249-4344
Mailing Address - Fax:
Practice Address - Street 1:9 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4802
Practice Address - Country:US
Practice Address - Phone:617-249-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN239049363LP0200X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics