Provider Demographics
NPI:1205003928
Name:WINNIKE, REBECCA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WINNIKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPT OF OB/GYN
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:310-356-4664
Mailing Address - Fax:319-384-8620
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4664
Practice Address - Fax:319-384-8620
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB104104367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1205003928OtherWELLMARK
IAP00876846OtherRAILROAD MEDICARE
IA1205003928Medicaid
IAI43730046Medicare PIN