Provider Demographics
NPI:1457424772
Name:CDEBACA, REBECCA ANNE (RNFA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:CDEBACA
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 GOODRICH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1136
Mailing Address - Country:US
Mailing Address - Phone:505-881-3064
Mailing Address - Fax:505-884-8046
Practice Address - Street 1:4416 GOODRICH AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1136
Practice Address - Country:US
Practice Address - Phone:505-881-3064
Practice Address - Fax:505-884-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR04485367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered