Provider Demographics
NPI:1851117758
Name:CARROLL, REBECCA (CRNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-2108
Mailing Address - Country:US
Mailing Address - Phone:570-954-2724
Mailing Address - Fax:
Practice Address - Street 1:199 HUGHES ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-2108
Practice Address - Country:US
Practice Address - Phone:570-954-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031157363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care