Provider Demographics
NPI:1568665206
Name:NEWBERRY, REBECCA L (RN, MS, CDE, APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:RN, MS, CDE, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-8797
Practice Address - Fax:402-354-5651
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42009163WD0400X
NE110904363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1568665206Medicaid
NE470376604-32Medicaid
NE110904OtherAPRN LICENSE
NE42009OtherRN LICENSE
NE470376604-32Medicaid