Provider Demographics
NPI:1912582313
Name:ANDERSON, MARY REBECCA (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:REBECCA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-6807
Mailing Address - Country:US
Mailing Address - Phone:828-649-2705
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6807
Practice Address - Country:US
Practice Address - Phone:828-649-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC331248163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care