Provider Demographics
NPI:1699982876
Name:WEBER, REBECCA ANN (CNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14432 LOWER GUTHRIE CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6744
Mailing Address - Country:US
Mailing Address - Phone:952-358-1535
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST # MS 11108B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4816
Practice Address - Fax:651-254-4816
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-093655-6163W00000X
MNR 0936556363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699982876OtherNPI