Provider Demographics
NPI:1376637108
Name:LADNER, REBECCA LYNN (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:LADNER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFA
Mailing Address - Street 1:2470 FLOWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:877-554-4257
Mailing Address - Fax:601-983-2845
Practice Address - Street 1:2470 FLOWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:877-554-4257
Practice Address - Fax:601-983-2845
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR753704163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant