MEDICARE: REBECCA LYNN CLARKIN RN

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	163WC0400X	Case Management Registered Nurse	R-135802-3	MN

General Provider Information

NPI Number	:	1336488493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN CLARKIN RN

Provider Business Mailing Address
First Line	:	20304 LORD RD
Second Line	:
City	:	MERRIFIELD
State	:	MN
Zip	:	56465-4180
Country	:	US
Telephone Number	:	218-330-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	20304 LORD RD
Second Line	:
City	:	MERRIFIELD
State	:	MN
Zip	:	56465-4180
Country	:	US
Telephone Number	:	218-330-2218
Fax Number	:

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

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	02/11/2013

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