Provider Demographics
NPI:1942954854
Name:WHITEHEAD, REBEKAH LYNN
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 EMMET ST APT 2
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2068
Mailing Address - Country:US
Mailing Address - Phone:734-250-3311
Mailing Address - Fax:
Practice Address - Street 1:611 EMMET ST APT 2
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2068
Practice Address - Country:US
Practice Address - Phone:734-250-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist