Provider Demographics
NPI:1497297717
Name:HINDERS, REBEKAH LEE (CPN P)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEE
Last Name:HINDERS
Suffix:
Gender:F
Credentials:CPN P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 CENTREVILLE RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-956-6301
Mailing Address - Fax:571-599-2800
Practice Address - Street 1:3914 CENTREVILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-956-6301
Practice Address - Fax:571-599-2800
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024173922363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics