Healthcare Provider Details

I. General information

NPI: 1386988731
Provider Name (Legal Business Name): HANNAH REBONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 QUAKER AVE
LUBBOCK TX
79424-3367
US

IV. Provider business mailing address

7501 QUAKER AVE
LUBBOCK TX
79424-3367
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-3306
  • Fax:
Mailing address:
  • Phone: 806-788-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number680080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: