Healthcare Provider Details

I. General information

NPI: 1609076272
Provider Name (Legal Business Name): REBECCA MARIE WOJAHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

362 EVANS LN LOT 4
SPEARFISH SD
57783-1157
US

V. Phone/Fax

Practice location:
  • Phone: 605-347-2511
  • Fax:
Mailing address:
  • Phone: 605-645-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR034425
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: