Provider Demographics
NPI:1346543725
Name:ROGHOLT, REBECCA IRENE (MS, RN, CNS)
Entity Type:Individual
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First Name:REBECCA
Middle Name:IRENE
Last Name:ROGHOLT
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Gender:F
Credentials:MS, RN, CNS
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Mailing Address - Street 1:1900 CENTRACARE CIRCLE #2475
Mailing Address - Street 2:CENTRACARE HEALTH PLAZA
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-229-5199
Mailing Address - Fax:320-229-5109
Practice Address - Street 1:1406 6TH AVENUE NORTH
Practice Address - Street 2:ST. CLOUD HOSPITAL
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-229-5109
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
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Provider Licenses
StateLicense IDTaxonomies
MNR147800-0364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health