Healthcare Provider Details

I. General information

NPI: 1679512420
Provider Name (Legal Business Name): REBECCA B. HARPOLD RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA B CHEATWOOD RN,MSN,FNP

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-855-5002
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-855-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: