Provider Demographics
NPI:1982472205
Name:PRIBLO, REBECCA STEWART (BSN, RN, CRNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:STEWART
Last Name:PRIBLO
Suffix:
Gender:F
Credentials:BSN, RN, CRNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:STEWART
Other - Last Name:LUKASZCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3141 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2875
Mailing Address - Country:US
Mailing Address - Phone:215-895-2000
Mailing Address - Fax:
Practice Address - Street 1:5445 LANARK RD STE 103
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8694
Practice Address - Country:US
Practice Address - Phone:484-526-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028873363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology