Provider Demographics
NPI:1700847340
Name:LOSSEN, REBECCA L (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:LOSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4868
Mailing Address - Country:US
Mailing Address - Phone:507-454-3650
Mailing Address - Fax:507-457-3392
Practice Address - Street 1:825 MANKATO AVE
Practice Address - Street 2:STE 210
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4866
Practice Address - Country:US
Practice Address - Phone:507-454-5050
Practice Address - Fax:507-454-5102
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42529207Q00000X
WI41645020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN201018600Medicaid
MN080010106Medicare ID - Type Unspecified
H06726Medicare UPIN