Provider Demographics
NPI:1336533298
Name:EVERETT, REBEKAH (LAT, ATC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11837 TOWER HAMLETS PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-6122
Mailing Address - Country:US
Mailing Address - Phone:240-419-0411
Mailing Address - Fax:
Practice Address - Street 1:11837 TOWER HAMLETS PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-6122
Practice Address - Country:US
Practice Address - Phone:240-419-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0000696146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic