Provider Demographics
NPI:1992580203
Name:MCNALLY, REBEKAH (RN: 2153544)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:RN: 2153544
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9708
Mailing Address - Country:US
Mailing Address - Phone:651-202-6034
Mailing Address - Fax:
Practice Address - Street 1:1200 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:651-202-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2153544163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics