Healthcare Provider Details

I. General information

NPI: 1629715537
Provider Name (Legal Business Name): REBEKAH LADUKE MSN, AG-ACCNS, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1896
US

IV. Provider business mailing address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2934
  • Fax:
Mailing address:
  • Phone: 517-364-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704263880NSA2103C
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: