Provider Demographics
NPI:1235156191
Name:ELBERT, REBECCA EVELYN (CNS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:EVELYN
Last Name:ELBERT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 INTERSTATE BLVD S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2257
Mailing Address - Country:US
Mailing Address - Phone:701-540-5547
Mailing Address - Fax:701-205-4593
Practice Address - Street 1:3220 4TH ST E STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:014-048-9697
Practice Address - Fax:701-203-0137
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR192572084P0800X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN551831800Medicaid
NDN711741Medicare PIN
Q59394Medicare UPIN