Provider Demographics
NPI:1851831663
Name:SWEEDE, REBECCA K (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:SWEEDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KATHERINE
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:495 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-476-6644
Mailing Address - Fax:541-476-5673
Practice Address - Street 1:MAST ONE 1040 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-397-6930
Practice Address - Fax:757-393-4864
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174558363L00000X
OR202008070NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10932Medicare PIN