Provider Demographics
NPI:1063249688
Name:WINGSTER, REBECCA J (MHA, RN, CCM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:WINGSTER
Suffix:
Gender:F
Credentials:MHA, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 E ELIZABETH DAY CV
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5189
Mailing Address - Country:US
Mailing Address - Phone:801-891-6470
Mailing Address - Fax:
Practice Address - Street 1:493 E ELIZABETH DAY CV
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5189
Practice Address - Country:US
Practice Address - Phone:801-891-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA807986163WC0400X
UT220502-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management