=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568078616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNA KAY REHM FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2020
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1161 WAYZATA BLVD E # 162
-----------------------------------------------------
City | WAYZATA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55391-1935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-373-3856
-----------------------------------------------------
Fax | 763-363-0333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8244 17TH AVE S
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-437-0511
-----------------------------------------------------
Fax | 763-363-0333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A160745
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 102720-875
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7938
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------