Provider Demographics
NPI:1518061894
Name:NISBY, REBECCA ANN (CNS-BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:NISBY
Suffix:
Gender:F
Credentials:CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 NORTH AVE
Mailing Address - Street 2:#14, 2ND FLOOR
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1306
Mailing Address - Country:US
Mailing Address - Phone:781-246-0020
Mailing Address - Fax:781-587-1397
Practice Address - Street 1:607 NORTH AVE
Practice Address - Street 2:#14 2ND FLOOR
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1306
Practice Address - Country:US
Practice Address - Phone:781-246-0020
Practice Address - Fax:781-587-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113629PC364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
216172000OtherMAGELLAN
MAPN0654OtherBCBS
308581OtherMHN (TRICARE)
MAPN0654OtherBCBS