Provider Demographics
NPI:1144866435
Name:CONNER, REBECCA P (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:CONNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BACH
Mailing Address - Street 2:1060 GAFNEY RD
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703
Mailing Address - Country:US
Mailing Address - Phone:907-353-3581
Mailing Address - Fax:907-353-3472
Practice Address - Street 1:BACH
Practice Address - Street 2:1060 GAFNEY RD
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-353-3581
Practice Address - Fax:907-353-3472
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72439163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management