Doctor Name: | REBECCA K DALLAS |
NPI Number: | 1013311653 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 5006981 |
Business Practice Address: | 1655 Wake Drive Suite 101 Wake Forest, NC - 275874746 |
Business Phone Number: | 9195564779 |
Business Fax Number: | 9195565277 |
Mailing Address: | 1655 Wake Drive, Suite 101 WAKE FOREST |
State: | NC |
Postal Code: | 275874746 |
Phone Number: | 9195564779 |
Fax Number: | 9195565277 |
NPI Enumeration Date: | 10/10/2014 |
NPI Last Update Date: | 10/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 5006981 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |