Provider Demographics
NPI:1679393748
Name:DEUSENBERRY, REBECCA S
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:DEUSENBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LITTLEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-5878
Mailing Address - Country:US
Mailing Address - Phone:304-709-4088
Mailing Address - Fax:
Practice Address - Street 1:18 LITTLEBROOK WAY
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-5878
Practice Address - Country:US
Practice Address - Phone:304-709-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker