Provider Demographics
NPI:1962888677
Name:WAUGH, REBECCA ELLEN (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELLEN
Last Name:WAUGH
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 306417
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6417
Mailing Address - Country:US
Mailing Address - Phone:931-253-1110
Mailing Address - Fax:
Practice Address - Street 1:1320 W STATE ROAD 2
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-4666
Practice Address - Country:US
Practice Address - Phone:931-253-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28138946A163WG0000X
IN71005656A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2920064Medicare PIN