Provider Demographics
NPI:1194099291
Name:CWIK, REBECCA A (NP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:CWIK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5908
Mailing Address - Fax:757-446-7055
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-446-5908
Practice Address - Fax:757-446-7055
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194099291OtherMULTIPLAN
VA10103536NOtherOPTIMA HEALTH
NC1194099291Medicaid
VA-033OtherTRICARE/CHAMPUS
VA1194099291OtherUSA MANAGED CARE
VA1194099291Medicaid
VA1194099291OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCORVEL
NC1194099291Medicaid
VAPAROtherCORVEL