Provider Demographics
NPI:1114195096
Name:SIGEL, REBECCA SUZANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUZANNE
Last Name:SIGEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W MEADOWS DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1776
Mailing Address - Country:US
Mailing Address - Phone:503-510-7385
Mailing Address - Fax:
Practice Address - Street 1:2744 BALD EAGLE AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4256
Practice Address - Country:US
Practice Address - Phone:503-991-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR682780Medicaid