MEDICARE: REBEKAH DALE BARD-CARVALHO FNP

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	363L00000X	Nurse Practitioner	14890	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821851213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH DALE BARD-CARVALHO FNP

Provider Business Mailing Address
First Line	:	3272 E THOMPSON AVE
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-4916
Country	:	US
Telephone Number	:	269-861-0688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3272 E THOMPSON AVE
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-4916
Country	:	US
Telephone Number	:	269-861-0688
Fax Number	:

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

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	10/04/2024

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