Provider Demographics
NPI:1497077721
Name:CAIN, REBECCA T (CRNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:CAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3060
Mailing Address - Country:US
Mailing Address - Phone:334-791-0897
Mailing Address - Fax:334-792-8019
Practice Address - Street 1:2346 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1276
Practice Address - Country:US
Practice Address - Phone:334-673-2501
Practice Address - Fax:334-673-2502
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1098487163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127468Medicaid
AL127468Medicaid