Provider Demographics
NPI:1568078616
Name:REHM, JOANNA KAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:KAY
Last Name:REHM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:KAY
Other - Last Name:FALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1158 ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:MN
Mailing Address - Zip Code:55089-9540
Mailing Address - Country:US
Mailing Address - Phone:651-385-4148
Mailing Address - Fax:
Practice Address - Street 1:1158 ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:MN
Practice Address - Zip Code:55089-9540
Practice Address - Country:US
Practice Address - Phone:612-438-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA160745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily