Provider Demographics
NPI:1467746610
Name:CHRISTIAN, REBECCA L (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 COUNTY ROAD TV
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-9503
Mailing Address - Country:US
Mailing Address - Phone:608-512-7557
Mailing Address - Fax:
Practice Address - Street 1:184 COUNTY ROAD TV
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-9503
Practice Address - Country:US
Practice Address - Phone:608-512-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30171431164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse