Healthcare Provider Details

I. General information

NPI: 1093034191
Provider Name (Legal Business Name): REBECKA MARIE EVANS R.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECKA MARIE MOWDY R.N.

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ALEXANDER AVE
BELMONT MA
02478-4802
US

IV. Provider business mailing address

9 ALEXANDER AVE
BELMONT MA
02478-4802
US

V. Phone/Fax

Practice location:
  • Phone: 617-249-4344
  • Fax:
Mailing address:
  • Phone: 617-249-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN239049
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN239049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: