Provider Demographics
NPI:1255876462
Name:DELAIN, REBECCA (RN, BSN,CDE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DELAIN
Suffix:
Gender:F
Credentials:RN, BSN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-4871
Mailing Address - Country:US
Mailing Address - Phone:920-465-0583
Mailing Address - Fax:
Practice Address - Street 1:616 AURORA DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-4871
Practice Address - Country:US
Practice Address - Phone:920-465-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85441163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator