Healthcare Provider Details

I. General information

NPI: 1063870046
Provider Name (Legal Business Name): REBECCA ANN HUKRIEDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA REIMANN PA-C

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 COUNTY RD 120
ST CLOUD MN
56303-4872
US

IV. Provider business mailing address

251 COUNTY RD 120
ST CLOUD MN
56303-4872
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-1313
  • Fax:
Mailing address:
  • Phone: 763-682-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2406
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: