Basic Information
| Provider Information | |||||||||
| NPI: | 1669850517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REBUCK | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E HILL AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379152565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658620998 | ||||||||
| FaxNumber: | 8655441861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1410 TUSCULUM BLVD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377455822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236390243 | ||||||||
| FaxNumber: | 4236390628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2015 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN197961 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | RN197961 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | CNP-03212 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.