Provider Demographics
NPI:1063639003
Name:REIDY, REBECCA LYNNE (ARNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNNE
Last Name:REIDY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2808
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220
Mailing Address - Country:US
Mailing Address - Phone:509-688-6702
Mailing Address - Fax:509-688-6792
Practice Address - Street 1:626 N MULLAN RD STE 16
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3858
Practice Address - Country:US
Practice Address - Phone:509-928-8585
Practice Address - Fax:509-928-2934
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily