Provider Demographics
NPI:1508292178
Name:KOOISTRA, REBECCA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:KOOISTRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1823
Mailing Address - Country:US
Mailing Address - Phone:919-942-8741
Mailing Address - Fax:919-942-1473
Practice Address - Street 1:7228 PITTSBORO-MONCURE RD
Practice Address - Street 2:
Practice Address - City:MONCURE
Practice Address - State:NC
Practice Address - Zip Code:27559
Practice Address - Country:US
Practice Address - Phone:919-542-4991
Practice Address - Fax:919-542-3726
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily