Provider Demographics
NPI:1972831055
Name:NEAD, REBECCA LYN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYN
Last Name:NEAD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYN
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3898
Mailing Address - Country:US
Mailing Address - Phone:480-773-6229
Mailing Address - Fax:
Practice Address - Street 1:1200 S 52ND ST BLDG T2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6922
Practice Address - Country:US
Practice Address - Phone:480-792-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily