Provider Demographics
NPI:1831603406
Name:STANIZZI, REBECCA J (CNM)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:STANIZZI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MERRIMACK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6240
Mailing Address - Country:US
Mailing Address - Phone:603-689-8679
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:19490 SANDRIDGE WAY STE 350
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3467
Practice Address - Country:US
Practice Address - Phone:703-858-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063364-23367A00000X
VA0024178260367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife