Provider Demographics
NPI:1689937419
Name:NEANDER, REBECCA BLOSSOM (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BLOSSOM
Last Name:NEANDER
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1300 W LANCASTER AVE STE 205
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3490
Practice Address - Country:US
Practice Address - Phone:817-336-8611
Practice Address - Fax:817-390-2981
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2021-04-14
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Provider Licenses
StateLicense IDTaxonomies
TXAP110428363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics