MEDICARE: REBECCA LUCIA BOECKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1124762364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LUCIA BOECKMAN

Provider Business Mailing Address
First Line	:	1617 PENNYWHISTLE ARCH
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8146
Country	:	US
Telephone Number	:	757-408-4890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 PENNYWHISTLE ARCH
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8146
Country	:	US
Telephone Number	:	757-408-4890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/25/2022

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