Provider Demographics
NPI:1679789267
Name:AHRENDSEN, REBECCA SUE (RN IBLCE)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:AHRENDSEN
Suffix:
Gender:F
Credentials:RN IBLCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-1241
Mailing Address - Country:US
Mailing Address - Phone:515-532-2565
Mailing Address - Fax:
Practice Address - Street 1:728 MAPLE LN
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-1241
Practice Address - Country:US
Practice Address - Phone:515-532-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063657163W00000X
IA19512249163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant