Provider Demographics
NPI:1518326784
Name:OETKEN, REBEKAH A (RN)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:A
Last Name:OETKEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:REBEKAH
Other - Middle Name:A
Other - Last Name:WASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:111843 MANN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4365
Mailing Address - Country:US
Mailing Address - Phone:715-615-2291
Mailing Address - Fax:
Practice Address - Street 1:111843 MANN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4365
Practice Address - Country:US
Practice Address - Phone:715-615-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319984-31164W00000X
WI234120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse