Healthcare Provider Details

I. General information

NPI: 1780103549
Provider Name (Legal Business Name): REBECCA ADELE HORRELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ADELE RUTLEDGE ARNP

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 87TH AVE
VANCOUVER WA
98664-4896
US

IV. Provider business mailing address

10503 NE 67TH AVE
VANCOUVER WA
98686-5103
US

V. Phone/Fax

Practice location:
  • Phone: 608-822-2778
  • Fax: 360-604-1693
Mailing address:
  • Phone: 360-326-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60793946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: