Provider Demographics
NPI:1730150863
Name:PERKS, REBEKAH (NP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:PERKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RAYMOND MEDICAL CENTER
Mailing Address - Street 2:470 GRANBY RD
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075
Mailing Address - Country:US
Mailing Address - Phone:413-533-7200
Mailing Address - Fax:413-794-8583
Practice Address - Street 1:470 GRANBY RD
Practice Address - Street 2:RAYMOND MEDICAL CENTER
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-3218
Practice Address - Country:US
Practice Address - Phone:413-533-7200
Practice Address - Fax:413-794-8583
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258361363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4700OtherBLUE CROSS BLUE SHIELD
MANP4700OtherBLUE CROSS BLUE SHIELD
MAQ23004Medicare UPIN