Provider Demographics
NPI:1902370745
Name:STIENSTRA, REBECCA (CRNA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STIENSTRA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:RUDENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 LINN ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1524
Mailing Address - Country:US
Mailing Address - Phone:708-302-3014
Mailing Address - Fax:
Practice Address - Street 1:555 LINN ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1524
Practice Address - Country:US
Practice Address - Phone:708-302-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI124783367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered