Provider Demographics
NPI:1568798700
Name:WERTISH, REBECCA L (CERTIFIED FAMILY NUR)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WERTISH
Suffix:
Gender:F
Credentials:CERTIFIED FAMILY NUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE, #2300
Mailing Address - Street 2:CENTRACARE CLINIC WOMEN'S & CHILDRENS/OB0GYN
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIRCLE, #2300
Practice Address - Street 2:CENTRACARE CLINIC WOMEN'S & CHILDRENS/OB0GYN
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-137104-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily