Provider Demographics
NPI:1366971681
Name:MAYER, REBECCA ANN (FNP-BC, APNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:MAYER
Suffix:
Gender:F
Credentials:FNP-BC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-928-6300
Mailing Address - Fax:
Practice Address - Street 1:703 W STATE ST
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:WI
Practice Address - Zip Code:53933-9550
Practice Address - Country:US
Practice Address - Phone:920-928-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7688-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily