Provider Demographics
NPI:1417753880
Name:NILSON, REBECCA ANNE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:NILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7680 COUNTY ROAD 625
Mailing Address - Street 2:
Mailing Address - City:NEW BROCKTON
Mailing Address - State:AL
Mailing Address - Zip Code:36351-6408
Mailing Address - Country:US
Mailing Address - Phone:912-856-8565
Mailing Address - Fax:
Practice Address - Street 1:7680 COUNTY ROAD 625
Practice Address - Street 2:
Practice Address - City:NEW BROCKTON
Practice Address - State:AL
Practice Address - Zip Code:36351-6408
Practice Address - Country:US
Practice Address - Phone:912-856-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-196380163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine