Provider Demographics
NPI:1700180098
Name:SYVERSON, REBEKAH ANNA (FNP-C)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANNA
Last Name:SYVERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 N MILWAUKEE ST # 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4425
Mailing Address - Country:US
Mailing Address - Phone:208-375-1072
Mailing Address - Fax:208-375-1072
Practice Address - Street 1:3271 N MILWAUKEE ST # 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4425
Practice Address - Country:US
Practice Address - Phone:208-375-1072
Practice Address - Fax:208-375-1673
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-31
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604412NP-PP363LF0000X
IDNP66749363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily