Provider Demographics
NPI:1063433357
Name:SLOCUM, REBEKAH S (CNP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:S
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4701
Mailing Address - Country:US
Mailing Address - Phone:540-342-7680
Mailing Address - Fax:540-342-7683
Practice Address - Street 1:1101 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4701
Practice Address - Country:US
Practice Address - Phone:540-342-7680
Practice Address - Fax:540-342-7683
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7799-NP363LP0200X
VA0024167406363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000370805OtherANTHEM
OH2573315Medicaid
OHQ50513Medicare UPIN
OH000000370805OtherANTHEM
OH2573315Medicaid