Provider Demographics
NPI:1790863025
Name:HOPPER, REBECCA (APN,C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HOPPER
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BRICK BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6048
Mailing Address - Country:US
Mailing Address - Phone:732-903-7186
Mailing Address - Fax:732-903-7187
Practice Address - Street 1:445 BRICK BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6048
Practice Address - Country:US
Practice Address - Phone:732-903-7186
Practice Address - Fax:732-903-7187
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11121600163W00000X
NJ26NJ00233300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse