Provider Demographics
NPI:1518664267
Name:HINES HAUDER, REBECCA JANE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:HINES HAUDER
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 1:1878 HUMMINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2222
Mailing Address - Country:US
Mailing Address - Phone:563-580-3767
Mailing Address - Fax:
Practice Address - Street 1:2255 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2846
Practice Address - Country:US
Practice Address - Phone:563-583-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist