Provider Demographics
NPI:1689920449
Name:WEATHERFORD, REBECCA TAWNEY (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:TAWNEY
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 RUTLEDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5566
Mailing Address - Country:US
Mailing Address - Phone:505-798-9300
Mailing Address - Fax:505-798-0808
Practice Address - Street 1:3741 RUTLEDGE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5566
Practice Address - Country:US
Practice Address - Phone:505-798-9300
Practice Address - Fax:505-798-0808
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02004363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology