Healthcare Provider Details

I. General information

NPI: 1326827759
Provider Name (Legal Business Name): REBEKAH DANIELLE LAFFERTY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOMESTEAD AVE
WHEELING WV
26003-6638
US

IV. Provider business mailing address

16972 STATE ROUTE 45
WELLSVILLE OH
43968-8709
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-1020
  • Fax:
Mailing address:
  • Phone: 740-275-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0034989
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: