Provider Demographics
NPI:1598027567
Name:STITH, REBECCA JENKINS (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JENKINS
Last Name:STITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4145
Mailing Address - Country:US
Mailing Address - Phone:318-547-7674
Mailing Address - Fax:
Practice Address - Street 1:1650 DESIARD ST FL 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7722
Practice Address - Country:US
Practice Address - Phone:318-361-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN088582163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health