Provider Demographics
NPI:1083931943
Name:MITCHARD, REBECCA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JANE
Last Name:MITCHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W GRANT ST
Mailing Address - Street 2:APT. 18J
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2309
Mailing Address - Country:US
Mailing Address - Phone:240-281-2284
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE STREET SE
Practice Address - Street 2:MMC 284 14-100 PHILLIPS-WANGENSTEEN BLDG
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0392
Practice Address - Country:US
Practice Address - Phone:612-625-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program