Provider Demographics
NPI:1427716000
Name:IRWIN, REBECCA ANN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BILLY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:WV
Mailing Address - Zip Code:25517-7803
Mailing Address - Country:US
Mailing Address - Phone:304-617-8158
Mailing Address - Fax:
Practice Address - Street 1:900 BILLY BRANCH RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:WV
Practice Address - Zip Code:25517-7803
Practice Address - Country:US
Practice Address - Phone:304-617-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant