Provider Demographics
NPI:1568794634
Name:STRAUB, REBECCA LYNN (RN)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LYNN
Last Name:STRAUB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3118
Mailing Address - Country:US
Mailing Address - Phone:920-819-0207
Mailing Address - Fax:
Practice Address - Street 1:1468 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3118
Practice Address - Country:US
Practice Address - Phone:920-819-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164636-030163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical