Provider Demographics
NPI:1457826612
Name:RIERSON, REBEKAH DANIELLE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DANIELLE
Last Name:RIERSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1928
Mailing Address - Country:US
Mailing Address - Phone:651-226-2977
Mailing Address - Fax:
Practice Address - Street 1:824 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1928
Practice Address - Country:US
Practice Address - Phone:651-226-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2468559163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse