Provider Demographics
NPI:1588800437
Name:MEYERS, REBECCA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3321 AUTUMN CHASE WAY NE
Mailing Address - Street 2:APT 104
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1169
Mailing Address - Country:US
Mailing Address - Phone:971-600-5016
Mailing Address - Fax:
Practice Address - Street 1:3321 AUTUMN CHASE WAY NE
Practice Address - Street 2:APT 104
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1169
Practice Address - Country:US
Practice Address - Phone:971-600-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200230295LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse