Healthcare Provider Details

I. General information

NPI: 1699982876
Provider Name (Legal Business Name): REBECCA ANN WEBER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST # MS 11108B
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

14432 LOWER GUTHRIE CT
APPLE VALLEY MN
55124-6744
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-4816
  • Fax: 651-254-4816
Mailing address:
  • Phone: 952-358-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-093655-6
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 0936556
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: