Healthcare Provider Details

I. General information

NPI: 1174717847
Provider Name (Legal Business Name): REBECCA ANN WIEBEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITH AVE N SUITE 300
SAINT PAUL MN
55102-2533
US

IV. Provider business mailing address

225 N. SMITH AVE SUITE 300
SAINT PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-726-6200
  • Fax:
Mailing address:
  • Phone: 651-726-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR-157185-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: