Provider Demographics
NPI:1245587658
Name:GAY, REBECCA SUE (CD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:GAY
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 COVENTRY POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4915
Mailing Address - Country:US
Mailing Address - Phone:561-577-8859
Mailing Address - Fax:
Practice Address - Street 1:4280 COVENTRY POINTE WAY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4915
Practice Address - Country:US
Practice Address - Phone:561-577-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula