Provider Demographics
NPI:1114695541
Name:LAFAVOR, REBECCA (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LAFAVOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ARABIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8207
Mailing Address - Country:US
Mailing Address - Phone:701-220-7008
Mailing Address - Fax:
Practice Address - Street 1:721 1ST AVE S STE A
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4725
Practice Address - Country:US
Practice Address - Phone:701-368-4380
Practice Address - Fax:701-540-6818
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily