Provider Demographics
NPI:1194376764
Name:REBEAUD, ELIZABETH ALLYSON
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALLYSON
Last Name:REBEAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-7001
Mailing Address - Country:US
Mailing Address - Phone:830-379-1828
Mailing Address - Fax:
Practice Address - Street 1:7 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-7001
Practice Address - Country:US
Practice Address - Phone:830-379-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider