Provider Demographics
NPI:1881643302
Name:COCCIA, REBECCA J (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:COCCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21333 HAGGERTY RD
Mailing Address - Street 2:STE 150
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5510
Mailing Address - Country:US
Mailing Address - Phone:248-662-0250
Mailing Address - Fax:
Practice Address - Street 1:4000 N MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-9744
Practice Address - Country:US
Practice Address - Phone:517-646-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170853363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2607932Medicaid
LA1594661Medicaid
MIP00249348OtherRR MEDICARE
ILP00274198OtherRR MCARE
MIP00249348OtherRR MEDICARE
LA4H571CH88Medicare ID - Type Unspecified
MIN69340006Medicare ID - Type Unspecified
OH2607932Medicaid
LA4H571CT60Medicare ID - Type Unspecified
MIN69350004Medicare ID - Type Unspecified
MIQ45071Medicare UPIN
ILK23394Medicare ID - Type UnspecifiedS IL