Provider Demographics
NPI:1255652954
Name:BAZANELE, REBEKAH MARIE (MED)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MARIE
Last Name:BAZANELE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:MARIE
Other - Last Name:NAPACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2869
Mailing Address - Country:US
Mailing Address - Phone:541-743-4340
Mailing Address - Fax:541-743-4369
Practice Address - Street 1:315 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2869
Practice Address - Country:US
Practice Address - Phone:541-743-4340
Practice Address - Fax:541-743-4369
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist