Provider Demographics
NPI:1225766835
Name:OLAUGHLIN, REBECCA JOY
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:OLAUGHLIN
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 1:707 BERNADETTE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2713
Mailing Address - Country:US
Mailing Address - Phone:410-332-7731
Mailing Address - Fax:
Practice Address - Street 1:707 BERNADETTE DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2713
Practice Address - Country:US
Practice Address - Phone:410-332-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily