Provider Demographics
NPI:1407306160
Name:LINDBERG, REBECKA
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SE C AVE
Mailing Address - Street 2:P.O. BOX 54
Mailing Address - City:GILMORE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50541-8798
Mailing Address - Country:US
Mailing Address - Phone:515-369-2293
Mailing Address - Fax:
Practice Address - Street 1:403 SE C AVE
Practice Address - Street 2:
Practice Address - City:GILMORE CITY
Practice Address - State:IA
Practice Address - Zip Code:50541-8798
Practice Address - Country:US
Practice Address - Phone:515-368-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP57933164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse