Provider Demographics
NPI:1770783714
Name:IRWIN, REBEKAH MARIE (APRN)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MARIE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0998
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:605-336-1677
Practice Address - Street 1:2100 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3646
Practice Address - Country:US
Practice Address - Phone:605-322-1010
Practice Address - Fax:605-322-1011
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000970363LA2100X, 363LA2200X
NE110863363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592302Medicaid
NE47070592300Medicaid
NE47070592306Medicaid
NE47070592301Medicaid
NE47070592313Medicaid
NE47070592305Medicaid
NENA1079047Medicare PIN
NE281667Medicare PIN
NE47070592301Medicaid