Provider Demographics
NPI:1881833309
Name:NORMAN, REBA A (LMP)
Entity Type:Individual
Prefix:MS
First Name:REBA
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2632
Mailing Address - Country:US
Mailing Address - Phone:509-965-5750
Mailing Address - Fax:
Practice Address - Street 1:208 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2632
Practice Address - Country:US
Practice Address - Phone:509-965-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist