MEDICARE: REBEKAH LAVONE RN, PHN, HNB-BC, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	234212-2	MN

General Provider Information

NPI Number	:	1164351318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH LAVONE RN, PHN, HNB-BC, BSN

Provider Business Mailing Address
First Line	:	11089 COTTONWOOD CIR NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-3340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11089 COTTONWOOD CIR NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-3340
Country	:	US
Telephone Number	:	612-227-6936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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