Provider Demographics
NPI:1619593761
Name:EDER, REBECCA JENN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JENN
Last Name:EDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1538
Mailing Address - Country:US
Mailing Address - Phone:218-391-8704
Mailing Address - Fax:
Practice Address - Street 1:1215 W KNAPP ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1307
Practice Address - Country:US
Practice Address - Phone:218-391-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical