Provider Demographics
NPI:1508064791
Name:RABKIN, JESSICIAH MARJORIE (APRN, ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICIAH
Middle Name:MARJORIE
Last Name:RABKIN
Suffix:
Gender:F
Credentials:APRN, ACNP-BC
Other - Prefix:MRS
Other - First Name:JESSICIAH
Other - Middle Name:MARJORIE
Other - Last Name:WINDFELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, ACNP-BC
Mailing Address - Street 1:PO BOX 581700
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1700
Mailing Address - Country:US
Mailing Address - Phone:801-581-2121
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0100
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6333357-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner