Provider Demographics
NPI:1558196063
Name:VAN DIEPENBOS, REBECCA LYNN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:VAN DIEPENBOS
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:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:ALKOL
Mailing Address - State:WV
Mailing Address - Zip Code:25501-0043
Mailing Address - Country:US
Mailing Address - Phone:574-238-8477
Mailing Address - Fax:
Practice Address - Street 1:3602 STRAIGHT FRK
Practice Address - Street 2:
Practice Address - City:YAWKEY
Practice Address - State:WV
Practice Address - Zip Code:25573-9666
Practice Address - Country:US
Practice Address - Phone:574-238-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant