Healthcare Provider Details

I. General information

NPI: 1053451773
Provider Name (Legal Business Name): REBECCA DEAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 E WASHINGTON AVE
MADISON WI
53704-4330
US

IV. Provider business mailing address

3002 BOSSHARD DR
FITCHBURG WI
53711-5858
US

V. Phone/Fax

Practice location:
  • Phone: 608-242-0220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: