Provider Demographics
NPI:1881616001
Name:AGNEW, REBECCA LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:AGNEW
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 1:5171 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2254
Mailing Address - Country:US
Mailing Address - Phone:412-683-4550
Mailing Address - Fax:412-683-8154
Practice Address - Street 1:5171 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2254
Practice Address - Country:US
Practice Address - Phone:412-683-4550
Practice Address - Fax:412-683-8154
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005610W363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS77002Medicare UPIN
PA025994Medicare ID - Type Unspecified