Doctor Name: | MS. REBECCA LYNNE FLACK |
NPI Number: | 1215212162 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | SP003728C |
Business Practice Address: | 109 Claypike Rd Acme, PA - 156102172 |
Business Phone Number: | 7244236589 |
Business Fax Number: | |
Mailing Address: | 109 Claypike Rd, ACME |
State: | PA |
Postal Code: | 156102172 |
Phone Number: | 7244236589 |
Fax Number: | |
NPI Enumeration Date: | 10/11/2011 |
NPI Last Update Date: | 10/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | SP003728C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |