Provider Demographics
NPI:1083435333
Name:REBOCK, ALEXIS (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:REBOCK
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 RACE ST UNIT 817
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1084
Mailing Address - Country:US
Mailing Address - Phone:856-905-3675
Mailing Address - Fax:
Practice Address - Street 1:3550 MARKET ST FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3368
Practice Address - Country:US
Practice Address - Phone:215-590-2178
Practice Address - Fax:215-590-4619
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030980363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics