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General NPI Number Information
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NPI Number | 1578911392
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Entity Type | Individual
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Provider Name | REBECCA KIREN NIGHTINGALE P.A.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 7238 MECHANICSVILLE TPKE
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3502
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Country | US
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Telephone | 804-559-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 20280 MARKET ST EASTERN SHORE RURAL HEALTH SYSTEM CORPORATE OFFICE
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City | ONANCOCK
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State | VA
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Zip | 23417-1331
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Country | US
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Telephone | 757-414-0400
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Fax | 757-414-0569
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110005380
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License Number State | VA
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