Provider Demographics
NPI:1871711143
Name:PODHORA, REBECCA ANN (PMHNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:PODHORA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8081 NW SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-8306
Mailing Address - Country:US
Mailing Address - Phone:541-233-7735
Mailing Address - Fax:541-566-7633
Practice Address - Street 1:190 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1820
Practice Address - Country:US
Practice Address - Phone:541-233-7735
Practice Address - Fax:541-566-7633
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20075001363LP0808X
OR200750010NP PMHNP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health