Provider Demographics
NPI:1912339698
Name:DRAHOTA, REBEKAH MAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MAE
Last Name:DRAHOTA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:MAE
Other - Last Name:KRAVCHONOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4700 POINT FOSDICK DR NW STE 202
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-858-9192
Mailing Address - Fax:
Practice Address - Street 1:4700 POINT FOSDICK DR NW STE 202
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-858-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60496649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily