MEDICARE: REBECCA LEA CHURCHMAN RN, CRNFA

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
1	163WR0006X	Registered Nurse First Assistant	462655	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	462655	OTHER	TX	LICENSED PROFESSIONAL RN

General Provider Information

NPI Number	:	1588783609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LEA CHURCHMAN RN, CRNFA

Provider Business Mailing Address
First Line	:	1823 ASH MEADOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2203
Country	:	US
Telephone Number	:	281-537-1618
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PEAKWOOD DR STE 8B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2904
Country	:	US
Telephone Number	:	281-580-6797
Fax Number	:	281-580-6693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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