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NPI Code Detail

MEDICARE: REBECCA ANNE NICKLE

MEDICARE: REBECCA ANNE NICKLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1063928471
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ANNE NICKLE
Provider Business Mailing Address
First Line : 501 CARL ST
Second Line :
City : NORFOLK
State : VA
Zip : 23505-4205
Country : US
Telephone Number : 618-954-3184
Fax Number :
Provider Business Practice Location Address
First Line : 501 CARL ST
Second Line :
City : NORFOLK
State : VA
Zip : 23505-4205
Country : US
Telephone Number : 618-954-3184
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2017
Last Update Date : 12/20/2017

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Directions to “ REBECCA ANNE NICKLE ” Practice Location

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