Provider Demographics
NPI:1891312690
Name:MARTIN, REBECCA DIANE (CRNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DIANE
Other - Last Name:SHEMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8121 EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9332
Mailing Address - Country:US
Mailing Address - Phone:717-315-6907
Mailing Address - Fax:
Practice Address - Street 1:19 SPRINT DR STE 2
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7002
Practice Address - Country:US
Practice Address - Phone:717-218-8888
Practice Address - Fax:717-243-6956
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily