Provider Demographics
NPI:1396563482
Name:GAFFORD, REBECCA MAGEE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAGEE
Last Name:GAFFORD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6891 SPRINGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4950
Mailing Address - Country:US
Mailing Address - Phone:225-939-2406
Mailing Address - Fax:
Practice Address - Street 1:6891 SPRINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4950
Practice Address - Country:US
Practice Address - Phone:225-939-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN080676163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice