Provider Demographics
NPI:1255770186
Name:OLDS, REBECKA MAY (NP-BC)
Entity type:Individual
Prefix:
First Name:REBECKA
Middle Name:MAY
Last Name:OLDS
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:REBECKA
Other - Middle Name:MAY
Other - Last Name:WINFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-BC
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:STE. 311
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-964-9490
Practice Address - Fax:248-964-9470
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248539363LA2200X, 363LP2300X, 364SG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology