Provider Demographics
NPI:1912122854
Name:WINN, REBECCA LS (NLMP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LS
Last Name:WINN
Suffix:
Gender:F
Credentials:NLMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 S GRAND DR
Mailing Address - Street 2:P.O. BOX 1986
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1836
Mailing Address - Country:US
Mailing Address - Phone:509-771-2700
Mailing Address - Fax:
Practice Address - Street 1:752 S GRAND DR
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1836
Practice Address - Country:US
Practice Address - Phone:509-771-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0143952OtherDEPARTMENT OF L&I