Healthcare Provider Details

I. General information

NPI: 1700666450
Provider Name (Legal Business Name): REBECCA KOBZA-GAGNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA KOBZA-GAGNE RN

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BROWN ST
FAIRHAVEN MA
02719-4302
US

IV. Provider business mailing address

6 BROWN ST
FAIRHAVEN MA
02719-4302
US

V. Phone/Fax

Practice location:
  • Phone: 508-801-1211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2334992
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: