Provider Demographics
NPI:1700980422
Name:NELSON, REBEKAH BERNICE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:BERNICE
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:BERNICE
Other - Last Name:HURTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1238 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2720
Mailing Address - Country:US
Mailing Address - Phone:360-636-9762
Mailing Address - Fax:
Practice Address - Street 1:1238 23RD AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2720
Practice Address - Country:US
Practice Address - Phone:360-636-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA AP30002015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily