Provider Demographics
NPI:1275422248
Name:RODRIGUEZ, REBECA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 STOCKING AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5176
Mailing Address - Country:US
Mailing Address - Phone:616-430-6494
Mailing Address - Fax:
Practice Address - Street 1:669 STOCKING AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5176
Practice Address - Country:US
Practice Address - Phone:616-430-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212639163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant