Provider Demographics
NPI:1790756583
Name:GARCIA, REBECCA STORMENT (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:STORMENT
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Mailing Address - Street 2:UHS 8EO
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-8211
Mailing Address - Fax:503-418-6318
Practice Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Practice Address - Street 2:UHS 8EO
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:318-281-3432
Practice Address - Fax:318-281-8850
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO5881363LF0000X
WAAP30006572363LF0000X
OR201050149NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9639550Medicaid
WARN00134924OtherRN LICENSE
LAAPO5881OtherLA NP LICENSE
LARN068123OtherLA RN LICENSE
WAAP30006572OtherARNP LICENSE NUMBER
WAAP30006572OtherARNP LICENSE NUMBER
WA9639550Medicaid
G8858239Medicare PIN