Provider Demographics
NPI:1285921080
Name:AMBERG, REBECCA L (LM RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:AMBERG
Suffix:
Gender:F
Credentials:LM RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:502 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1648
Mailing Address - Country:US
Mailing Address - Phone:608-387-0153
Mailing Address - Fax:715-284-2003
Practice Address - Street 1:502 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615
Practice Address - Country:US
Practice Address - Phone:608-387-0153
Practice Address - Fax:715-284-2003
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI147290-30163W00000X
WI275-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse