Healthcare Provider Details

I. General information

NPI: 1447048079
Provider Name (Legal Business Name): REBECCA RAE KOJAK DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 EIGHTEEN GRAND PL
COOKEVILLE TN
38506-4933
US

IV. Provider business mailing address

103 EIGHTEEN GRAND PL
COOKEVILLE TN
38506-4933
US

V. Phone/Fax

Practice location:
  • Phone: 651-503-7311
  • Fax:
Mailing address:
  • Phone: 651-503-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number244556
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: