Provider Demographics
NPI:1063003895
Name:SVADLENKA, REBEKAH M (NP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:M
Last Name:SVADLENKA
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 1:1672 S WOODSAGE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8332
Mailing Address - Country:US
Mailing Address - Phone:085-152-2732
Mailing Address - Fax:
Practice Address - Street 1:1672 S WOODSAGE AVE STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8332
Practice Address - Country:US
Practice Address - Phone:208-515-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1975040363LP0808X
FLAPRN11017405363LP0808X
ID77692363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health