Provider Demographics
NPI:1760050629
Name:COX-DAVENPORT, REBECCA (CRNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COX-DAVENPORT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SALISBURY CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5165
Mailing Address - Country:US
Mailing Address - Phone:412-373-0346
Mailing Address - Fax:
Practice Address - Street 1:100 N CAMERON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2424
Practice Address - Country:US
Practice Address - Phone:717-233-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine