Basic Information
| Provider Information | |||||||||
| NPI: | 1194099291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CWIK | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | EVMS MEDICAL GROUP | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465908 | ||||||||
| FaxNumber: | 7574467055 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRESHAM DR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465908 | ||||||||
| FaxNumber: | 7574467055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2012 | ||||||||
| LastUpdateDate: | 02/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024169928 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1194099291 | 01 | VA | MULTIPLAN | OTHER | 10103536N | 01 | VA | OPTIMA HEALTH | OTHER | 1194099291 | 05 | NC | MEDICAID | -033 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1194099291 | 01 | VA | USA MANAGED CARE | OTHER | 1194099291 | 05 | VA | MEDICAID | 1194099291 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | PAR | 01 | VA | CORVEL | OTHER |