Provider Demographics
NPI:1174039358
Name:MCNICOL, REBECCA LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:MCNICOL
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:9419 CHARTER GATE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5171
Mailing Address - Country:US
Mailing Address - Phone:804-426-3353
Mailing Address - Fax:
Practice Address - Street 1:10571 TELEGRAPH RD STE 110
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4652
Practice Address - Country:US
Practice Address - Phone:804-266-9616
Practice Address - Fax:804-261-4935
Is Sole Proprietor?:No
Enumeration Date:2017-12-25
Last Update Date:2017-12-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024175314363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics