Provider Demographics
NPI:1770063547
Name:LYLE, REBECCA JANE (CNM, FNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JANE
Last Name:LYLE
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, FNP
Mailing Address - Street 1:407 S MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-4000
Mailing Address - Country:US
Mailing Address - Phone:608-637-3174
Mailing Address - Fax:608-638-5038
Practice Address - Street 1:407 S MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-4000
Practice Address - Country:US
Practice Address - Phone:608-637-3174
Practice Address - Fax:608-638-5038
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8605-33363L00000X
WI148954367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife