Provider Demographics
NPI:1598216335
Name:STUTZMAN, REBEKAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HAMILTON AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4015
Mailing Address - Country:US
Mailing Address - Phone:330-412-0707
Mailing Address - Fax:
Practice Address - Street 1:365 HAMILTON AVE NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4015
Practice Address - Country:US
Practice Address - Phone:330-412-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.312002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily