Provider Demographics
NPI:1487248266
Name:MEADE, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MEADE
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 1:103 MOSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERSTDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25607-8047
Mailing Address - Country:US
Mailing Address - Phone:681-352-4013
Mailing Address - Fax:
Practice Address - Street 1:103 MOSLEY AVE
Practice Address - Street 2:
Practice Address - City:AMHERSTDALE
Practice Address - State:WV
Practice Address - Zip Code:25607-8047
Practice Address - Country:US
Practice Address - Phone:681-352-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker