1790756583 NPI number — REBECCA STORMENT GARCIA NP

Table of content: REBECCA STORMENT GARCIA NP (NPI 1790756583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790756583 NPI number — REBECCA STORMENT GARCIA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
REBECCA
Provider Middle Name:
STORMENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790756583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3181 SW SAM JACKSON PARK ROAD
Provider Second Line Business Mailing Address:
UHS 8EO
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-8211
Provider Business Mailing Address Fax Number:
503-418-6318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK ROAD
Provider Second Line Business Practice Location Address:
UHS 8EO
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-281-3432
Provider Business Practice Location Address Fax Number:
318-281-8850
Provider Enumeration Date:
01/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APO5881 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30006572 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 201050149NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9639550 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RN00134924 . This is a "RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: APO5881 . This is a "LA NP LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: RN068123 . This is a "LA RN LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: AP30006572 . This is a "ARNP LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".