Provider Demographics
NPI:1568711810
Name:PATEL, REBECCA SUE (NP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:PATEL
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:SUFFETY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-BC
Mailing Address - Street 1:149 PARKWAY CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4571
Mailing Address - Country:US
Mailing Address - Phone:870-918-8057
Mailing Address - Fax:
Practice Address - Street 1:120 KINGS WAY STE 2700
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2554
Practice Address - Country:US
Practice Address - Phone:757-221-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily