Provider Demographics
NPI:1376210815
Name:BELFONTI, REBECCA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BELFONTI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:GOUGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:531 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9517
Mailing Address - Country:US
Mailing Address - Phone:609-402-1357
Mailing Address - Fax:
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024276363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care