Provider Demographics
NPI:1841486776
Name:FAHNING, REBECCA LYNNE (RDH, BS, IBCLC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNNE
Last Name:FAHNING
Suffix:
Gender:F
Credentials:RDH, BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13410 CANALVILLE LN
Mailing Address - Street 2:
Mailing Address - City:GRASSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55030-2162
Mailing Address - Country:US
Mailing Address - Phone:651-894-4391
Mailing Address - Fax:320-629-3366
Practice Address - Street 1:13410 CANALVILLE LN
Practice Address - Street 2:
Practice Address - City:GRASSTON
Practice Address - State:MN
Practice Address - Zip Code:55030-2162
Practice Address - Country:US
Practice Address - Phone:651-894-4391
Practice Address - Fax:320-629-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH5749124Q00000X
MN174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN