Provider Demographics
NPI:1134460785
Name:NAZARCHUK, REBEKAH ILENE (MS)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ILENE
Last Name:NAZARCHUK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MARION ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1812
Mailing Address - Country:US
Mailing Address - Phone:570-430-0913
Mailing Address - Fax:
Practice Address - Street 1:112 MARION ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1812
Practice Address - Country:US
Practice Address - Phone:570-430-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor