Provider Demographics
NPI:1639638372
Name:STILLWELL, REBECCA (AP 60897709)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:AP 60897709
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SHORTCUT ROAD
Mailing Address - Street 2:
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138
Mailing Address - Country:US
Mailing Address - Phone:509-722-7006
Mailing Address - Fax:509-722-3652
Practice Address - Street 1:39 SHORTCUT ROAD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138
Practice Address - Country:US
Practice Address - Phone:509-722-7006
Practice Address - Fax:509-722-3652
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60897709363LF0000X
WA60897709363L00000X
WARN00148167163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse