Provider Demographics
NPI:1699199257
Name:GAYHARDT, REBECCA ANN (FNP-C, CRNA, DNP)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:GAYHARDT
Suffix:
Gender:F
Credentials:FNP-C, CRNA, DNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:DEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, MSN
Mailing Address - Street 1:180 BANGOR MALL BLVD # 1023
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3632
Mailing Address - Country:US
Mailing Address - Phone:972-762-8610
Mailing Address - Fax:
Practice Address - Street 1:501 S BURMA AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:972-762-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347676363LF0000X
TXAP125314363LF0000X
WY54024367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily