Provider Demographics
NPI:1245624964
Name:REHAK, PAUL TERRENCE (RN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:TERRENCE
Last Name:REHAK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E PINEY BRANCH DR
Mailing Address - Street 2:APT. 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6770
Mailing Address - Country:US
Mailing Address - Phone:757-285-8809
Mailing Address - Fax:
Practice Address - Street 1:960 E PINEY BRANCH DR
Practice Address - Street 2:APT. 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6770
Practice Address - Country:US
Practice Address - Phone:757-285-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001218398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse