Provider Demographics
NPI:1427421312
Name:ISHOLA, REBECCA DAWN (APRN, WHNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DAWN
Last Name:ISHOLA
Suffix:
Gender:F
Credentials:APRN, WHNP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:DAWN
Other - Last Name:COWEN/LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, WHNP
Mailing Address - Street 1:48 MDG
Mailing Address - Street 2:UNIT 5115
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461
Mailing Address - Country:US
Mailing Address - Phone:314-226-8379
Mailing Address - Fax:
Practice Address - Street 1:48 MDG
Practice Address - Street 2:UNIT 5115
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461
Practice Address - Country:US
Practice Address - Phone:314-226-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-31116163WM0102X
IDNP-1644A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn