Provider Demographics
NPI:1649731431
Name:WYLAND, REBECCA LYNN (QMHA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:WYLAND
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1502
Mailing Address - Country:US
Mailing Address - Phone:541-610-8870
Mailing Address - Fax:
Practice Address - Street 1:601 WHISKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:WALLOWA
Practice Address - State:OR
Practice Address - Zip Code:97885-7129
Practice Address - Country:US
Practice Address - Phone:541-886-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator