Provider Demographics
NPI:1831538859
Name:TIMCZYK, REBECCA L (CRNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:TIMCZYK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 MEMORIAL BLVD
Mailing Address - Street 2:A
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1405
Mailing Address - Country:US
Mailing Address - Phone:724-603-3560
Mailing Address - Fax:
Practice Address - Street 1:2614 MEMORIAL BLVD
Practice Address - Street 2:A
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1405
Practice Address - Country:US
Practice Address - Phone:724-603-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012719363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027926200001Medicaid