Provider Demographics
NPI:1316910078
Name:PEIL, REBECCA WHARTON (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:WHARTON
Last Name:PEIL
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
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Mailing Address - Street 1:PO BOX 8500, LOCKBOX 7642
Mailing Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN PORTLAND
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-413-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP2076363LF0000X
OR200850117NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200850117NPOtherLICENSE
AZ984353Medicaid