Provider Demographics
NPI:1922085117
Name:BARROSO, REBECA (CNM)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:BARROSO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 COUNTY ROAD E W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8152
Mailing Address - Country:US
Mailing Address - Phone:651-490-0433
Mailing Address - Fax:651-490-4568
Practice Address - Street 1:1030 COUNTY ROAD E W
Practice Address - Street 2:SUITE 200
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8152
Practice Address - Country:US
Practice Address - Phone:651-490-0433
Practice Address - Fax:651-490-4568
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-108235-7367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA3481012050OtherPREFERRED ONE
MN50D78BAOtherBLUECROSS-BLUESHIELD
MN07-02129OtherMEDICA