Provider Demographics
NPI:1366319618
Name:WILLGRUBER, REBECCA (CRNP, CPNP-PC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WILLGRUBER
Suffix:
Gender:F
Credentials:CRNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 COATES LN
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2556
Mailing Address - Country:US
Mailing Address - Phone:610-952-7906
Mailing Address - Fax:
Practice Address - Street 1:611 COATES LN
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2556
Practice Address - Country:US
Practice Address - Phone:610-952-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033697363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics