Provider Demographics
NPI:1629269725
Name:SAFER, REBECCA RAE (RN)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:RAE
Last Name:SAFER
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 1:1115 HWY C
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9727
Mailing Address - Country:US
Mailing Address - Phone:414-303-0166
Mailing Address - Fax:
Practice Address - Street 1:7932 GRIDLEY AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3170
Practice Address - Country:US
Practice Address - Phone:414-727-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35038200Medicaid