Provider Demographics
NPI:1972234144
Name:LACLAIRE, REBECCA MARIE (QSP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:LACLAIRE
Suffix:
Gender:F
Credentials:QSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 UNIVERSITY DR LOT 1609
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6614
Mailing Address - Country:US
Mailing Address - Phone:701-946-0988
Mailing Address - Fax:
Practice Address - Street 1:1119 UNIVERSITY DR LOT 1609
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6614
Practice Address - Country:US
Practice Address - Phone:701-946-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2023-11-24
Deactivation Date:2023-11-08
Deactivation Code:
Reactivation Date:2023-11-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant