Provider Demographics
NPI:1942672704
Name:HAYWOOD, REBEKAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:51 MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562-1400
Mailing Address - Country:US
Mailing Address - Phone:717-635-0595
Mailing Address - Fax:
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-1437
Practice Address - Country:US
Practice Address - Phone:301-359-5145
Practice Address - Fax:301-359-5178
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN84484-NP-C363LF0000X
MDR219448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily