1982472205 NPI number — REBECCA STEWART PRIBLO BSN, RN, CRNP

Table of content: BEV ORRILL (NPI 1639825128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982472205 NPI number — REBECCA STEWART PRIBLO BSN, RN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRIBLO
Provider First Name:
REBECCA
Provider Middle Name:
STEWART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUKASZCZYK
Provider Other First Name:
REBECCA
Provider Other Middle Name:
STEWART
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982472205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3141 CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-2875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-895-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5445 LANARK RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18034-8694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-526-7035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2023

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: 363LA2200X , with the licence number:  SP028873 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: SP028873 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: SP028873 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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