Provider Demographics
NPI:1548727761
Name:DRIESENGA, REBEKAH MAE
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MAE
Last Name:DRIESENGA
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 1:4870 STELLA CT UNIT 105
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:WI
Mailing Address - Zip Code:54155-9321
Mailing Address - Country:US
Mailing Address - Phone:906-287-0876
Mailing Address - Fax:
Practice Address - Street 1:4870 STELLA CT UNIT 105
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:WI
Practice Address - Zip Code:54155-9321
Practice Address - Country:US
Practice Address - Phone:906-287-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI240125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse