Provider Demographics
NPI:1215212162
Name:FLACK, REBECCA LYNNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNNE
Last Name:FLACK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CLAYPIKE RD
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:PA
Mailing Address - Zip Code:15610-2172
Mailing Address - Country:US
Mailing Address - Phone:724-423-6589
Mailing Address - Fax:
Practice Address - Street 1:109 CLAYPIKE RD
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:PA
Practice Address - Zip Code:15610-2172
Practice Address - Country:US
Practice Address - Phone:724-423-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003728C363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology