Healthcare Provider Details

I. General information

NPI: 1770826240
Provider Name (Legal Business Name): KATHRYN JEANNE REBEDEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN JEANNE GESBECK

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax:
Mailing address:
  • Phone: 608-263-8557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62818
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: