Provider Demographics
NPI:1134308679
Name:MACDONALD, REBECCA MARIE (BSRT (M)(R)(CDT))
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:BSRT (M)(R)(CDT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 UNIVERSITY DR LOT 1511
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6614
Mailing Address - Country:US
Mailing Address - Phone:701-258-6083
Mailing Address - Fax:
Practice Address - Street 1:1119 UNIVERSITY DR LOT 1511
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6614
Practice Address - Country:US
Practice Address - Phone:701-258-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3820882471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
382088OtherARRT