Provider Demographics
NPI:1417096868
Name:MARASCO, REBBEKKAH C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:REBBEKKAH
Middle Name:C
Last Name:MARASCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:REBBEKKAH
Other - Middle Name:CHRISTINE
Other - Last Name:RUSSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9190412363LF0000X
FLARNP9347400363LF0000X
MI4704274418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2818ZMedicare PIN
FLQ19609Medicare UPIN