Provider Demographics
NPI:1942832563
Name:WOLLENMAN, REBEKAH CAGNEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:CAGNEY
Last Name:WOLLENMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 N FITZHUGH AVE APT 2305
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3294
Mailing Address - Country:US
Mailing Address - Phone:214-538-2401
Mailing Address - Fax:
Practice Address - Street 1:2737 N FITZHUGH AVE APT 2305
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3294
Practice Address - Country:US
Practice Address - Phone:214-538-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily