Provider Demographics
NPI:1629778709
Name:ATANODE, REBECCA BUMIA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BUMIA
Last Name:ATANODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7264 ROBLE GRANDPRAIRE
Mailing Address - Street 2:
Mailing Address - City:GRANDPRAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:75054
Mailing Address - Country:US
Mailing Address - Phone:469-544-7817
Mailing Address - Fax:
Practice Address - Street 1:7264 ROBLE GRANDPRAIRE
Practice Address - Street 2:
Practice Address - City:GRANDPRAIRE
Practice Address - State:TX
Practice Address - Zip Code:75054
Practice Address - Country:US
Practice Address - Phone:469-544-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty