Provider Demographics
NPI:1740532720
Name:GUY, REBECCA LEE (MSN, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:GUY
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DERING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:ID
Mailing Address - Zip Code:83676-5542
Mailing Address - Country:US
Mailing Address - Phone:208-482-7430
Mailing Address - Fax:208-482-7272
Practice Address - Street 1:124 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:ID
Practice Address - Zip Code:83676-5542
Practice Address - Country:US
Practice Address - Phone:208-482-7430
Practice Address - Fax:208-482-7272
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1220A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily