Provider Demographics
NPI:1598744997
Name:WHITE, REBEKAH ROSE (CNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ROSE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13359 ISLE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-2223
Mailing Address - Country:US
Mailing Address - Phone:218-454-7546
Mailing Address - Fax:
Practice Address - Street 1:13359 ISLE DR STE 3
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-2223
Practice Address - Country:US
Practice Address - Phone:218-454-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR171566-6363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04747Medicare UPIN
MN070000780Medicare PIN