Healthcare Provider Details

I. General information

NPI: 1659186492
Provider Name (Legal Business Name): REBECCA LYNN TRASK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN MORGAN

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

14607 OCONNELL RD
SAVAGE MN
55378-2848
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-6080
  • Fax:
Mailing address:
  • Phone: 952-838-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2083245
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: