Provider Demographics
NPI:1215215801
Name:RAPOPORT, REBECCA ERIN (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ERIN
Last Name:RAPOPORT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 GILMAN ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2455
Mailing Address - Country:US
Mailing Address - Phone:401-481-2103
Mailing Address - Fax:
Practice Address - Street 1:536 W 111TH ST APT 63
Practice Address - Street 2:APARTMENT 63
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1957
Practice Address - Country:US
Practice Address - Phone:401-481-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22690363LP0200X
NYF382227-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics