Provider Demographics
NPI:1366106668
Name:LONGFORS, REBECCA RENEE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RENEE
Last Name:LONGFORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2432
Mailing Address - Country:US
Mailing Address - Phone:218-770-6357
Mailing Address - Fax:
Practice Address - Street 1:101 LAURA LN
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2432
Practice Address - Country:US
Practice Address - Phone:218-770-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1524844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse