Provider Demographics
NPI:1386612661
Name:MEINECKE, REBECCA J (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:MEINECKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1898
Practice Address - Country:US
Practice Address - Phone:320-634-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN403287000Medicaid
MN970001329OtherMEDICARE WPS - HOSPITAL
MN970001697OtherMEDICARE WPS - MCGREGOR C
MN970001330OtherMEDICARE WPS - AITKIN CLI
MN970001329OtherMEDICARE WPS - HOSPITAL