Provider Demographics
NPI:1043068620
Name:PEDERSON, REBECCA ILENE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ILENE
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ILENE
Other - Last Name:HAMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8750 BERGIN RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8045
Mailing Address - Country:US
Mailing Address - Phone:810-588-0227
Mailing Address - Fax:
Practice Address - Street 1:8750 BERGIN RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8045
Practice Address - Country:US
Practice Address - Phone:810-588-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty