Healthcare Provider Details

I. General information

NPI: 1982472205
Provider Name (Legal Business Name): REBECCA STEWART PRIBLO BSN, RN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA STEWART LUKASZCZYK

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 01/29/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LANARK RD STE 103
CENTER VALLEY PA
18034-8694
US

IV. Provider business mailing address

3141 CHESTNUT ST
PHILADELPHIA PA
19104-2875
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7035
  • Fax:
Mailing address:
  • Phone: 215-895-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP028873
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP028873
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP028873
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: