Provider Demographics
NPI:1154027639
Name:REBENACK, MICHELLE RENEE (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:REBENACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 E 186TH ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7827
Mailing Address - Country:US
Mailing Address - Phone:765-804-8044
Mailing Address - Fax:855-225-0295
Practice Address - Street 1:937 E 186TH ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7827
Practice Address - Country:US
Practice Address - Phone:765-804-8044
Practice Address - Fax:855-225-0295
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28178788A163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice