Provider Demographics
NPI:1356195606
Name:REBOUND HEALTH SERVICE LLC
Entity type:Organization
Organization Name:REBOUND HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKUA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN , CNP
Authorized Official - Phone:507-398-7799
Mailing Address - Street 1:2670 CENTURY STONE LN NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-7704
Mailing Address - Country:US
Mailing Address - Phone:507-398-7799
Mailing Address - Fax:
Practice Address - Street 1:1027 7TH ST NW STE 204
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2666
Practice Address - Country:US
Practice Address - Phone:507-398-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric