Healthcare Provider Details

I. General information

NPI: 1821345844
Provider Name (Legal Business Name): REBECCA WHITE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W SAINT GERMAIN ST
SAINT CLOUD MN
56301-4101
US

IV. Provider business mailing address

1400 W SAINT GERMAIN ST
SAINT CLOUD MN
56301-4101
US

V. Phone/Fax

Practice location:
  • Phone: 202-976-8003
  • Fax: 320-297-6700
Mailing address:
  • Phone: 320-297-6800
  • Fax: 320-297-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1672563
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number52
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: