Provider Demographics
NPI:1093945347
Name:BEECH, REBA L (CRNP)
Entity Type:Individual
Prefix:MS
First Name:REBA
Middle Name:L
Last Name:BEECH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 229
Mailing Address - Street 2:20976 HWY. 43
Mailing Address - City:WAGARVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36585
Mailing Address - Country:US
Mailing Address - Phone:251-769-1430
Mailing Address - Fax:
Practice Address - Street 1:20976 HWY. 43
Practice Address - Street 2:
Practice Address - City:WAGARVILLE
Practice Address - State:AL
Practice Address - Zip Code:36585
Practice Address - Country:US
Practice Address - Phone:251-769-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069300363LF0000X
MSR857734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS55963Medicare UPIN