Provider Demographics
NPI:1578712774
Name:ANDERSON, REBECCA JANE (LMP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 D ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3332
Mailing Address - Country:US
Mailing Address - Phone:360-772-6294
Mailing Address - Fax:
Practice Address - Street 1:1815 D ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3332
Practice Address - Country:US
Practice Address - Phone:360-772-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023541171W00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No173C00000XOther Service ProvidersReflexologist