Provider Demographics
NPI:1376605972
Name:HUFFSTUTLER, REBECCA DIANNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DIANNE
Last Name:HUFFSTUTLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12255 FAIR LAKES PARKWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4512
Practice Address - Country:US
Practice Address - Phone:703-934-5700
Practice Address - Fax:703-934-5778
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024133877363L00000X
VA0001133877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81463Medicare UPIN