Healthcare Provider Details

I. General information

NPI: 1336488493
Provider Name (Legal Business Name): REBECCA LYNN CLARKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20304 LORD RD
MERRIFIELD MN
56465-4180
US

IV. Provider business mailing address

20304 LORD RD
MERRIFIELD MN
56465-4180
US

V. Phone/Fax

Practice location:
  • Phone: 218-330-2218
  • Fax:
Mailing address:
  • Phone: 218-330-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR-135802-3
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: