Provider Demographics
NPI:1689401432
Name:STULL, REBECCA MICHELLE (PNP-PC, RN)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:MICHELLE
Last Name:STULL
Suffix:
Gender:F
Credentials:PNP-PC, RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1235 W TOWN AND COUNTRY RD APT 3423
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4677
Mailing Address - Country:US
Mailing Address - Phone:909-631-5496
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-660-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95030984363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics