Provider Demographics
NPI:1376879189
Name:CHRISTIAN, REBEL RENEA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBEL
Middle Name:RENEA
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:REBEL
Other - Middle Name:RENEA
Other - Last Name:GILLENWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-524-7284
Mailing Address - Fax:
Practice Address - Street 1:7400 LYNN AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1138
Practice Address - Country:US
Practice Address - Phone:304-824-5806
Practice Address - Fax:304-824-5885
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62507-RN 2009007356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016640Medicaid
WVWV1594GMedicare Oscar/Certification
WVWV1594B663Medicare Oscar/Certification
WV3810016640Medicaid
WVWV1594AMedicare Oscar/Certification
WVWV1594B662Medicare Oscar/Certification
WVWV1594DMedicare Oscar/Certification
WV2033171Medicare Oscar/Certification
WVWV1594EMedicare Oscar/Certification
WVWV1594CMedicare Oscar/Certification
WVWV1594FMedicare Oscar/Certification