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General NPI Number Information
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NPI Number | 1386398535
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Entity Type | Individual
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Provider Name | REBEKAH C MEDEIROS NP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 593 EDDY ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-5435
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Fax | 401-444-8301
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Provider Business Mailing Address
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Address Line | 117 ELLENFIELD ST STE 101
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City | PROVIDENCE
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State | RI
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Zip | 02905-4541
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN63513
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN03911
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License Number State | RI
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