Provider Demographics
NPI:1750865283
Name:TRANTHAM, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TRANTHAM
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 1:103 STATE HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:LOTT
Mailing Address - State:TX
Mailing Address - Zip Code:76656-3574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 STATE HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LOTT
Practice Address - State:TX
Practice Address - Zip Code:76656-3574
Practice Address - Country:US
Practice Address - Phone:254-493-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149887164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse