Provider Demographics
NPI:1144201757
Name:GILBERTSON, REBECCA ELAINE (DNP CNM FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELAINE
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:DNP CNM FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1307
Mailing Address - Country:US
Mailing Address - Phone:715-748-5580
Mailing Address - Fax:715-748-5582
Practice Address - Street 1:811 W. BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1586
Practice Address - Country:US
Practice Address - Phone:715-748-5580
Practice Address - Fax:715-748-5582
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1282363LF0000X
WI108463367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife