Provider Demographics
NPI:1659369189
Name:EPP, REBECCA M (CRNA, MSN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:EPP
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:CECALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:610 W GERMANTOWN PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1062
Mailing Address - Country:US
Mailing Address - Phone:610-525-4966
Mailing Address - Fax:
Practice Address - Street 1:610 W GERMANTOWN PIKE STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1062
Practice Address - Country:US
Practice Address - Phone:610-525-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0030922163W00000X
DEL6-0A00370367500000X
PARN519113L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001956396Medicaid
PAP00670037OtherRAILROAD MEDICARE
54683OtherAANA
DEP00795646OtherRAILROAD MEDICARE
PA065469Medicare PIN
54683OtherAANA