Provider Demographics
NPI:1124762364
Name:BOECKMAN, REBECCA LUCIA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LUCIA
Last Name:BOECKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 PENNYWHISTLE ARCH
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8146
Mailing Address - Country:US
Mailing Address - Phone:757-408-4890
Mailing Address - Fax:
Practice Address - Street 1:1617 PENNYWHISTLE ARCH
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-8146
Practice Address - Country:US
Practice Address - Phone:757-408-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator