Provider Demographics
NPI:1497349336
Name:HARTSFIELD, REBECCA DONNELL (CRANIAL PROSTHESIS)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DONNELL
Last Name:HARTSFIELD
Suffix:
Gender:F
Credentials:CRANIAL PROSTHESIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4530
Mailing Address - Country:US
Mailing Address - Phone:936-635-8591
Mailing Address - Fax:
Practice Address - Street 1:210 SUSIE ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5077
Practice Address - Country:US
Practice Address - Phone:936-635-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1565838332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment