Provider Demographics
NPI:1730159328
Name:MAY, REBECCA L (ANP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MAY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1865
Mailing Address - Country:US
Mailing Address - Phone:218-927-2157
Mailing Address - Fax:218-927-4130
Practice Address - Street 1:200 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1865
Practice Address - Country:US
Practice Address - Phone:218-927-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0802842363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500003858OtherMEDICARE WPS HOSPITAL
MN500000267OtherMEDICARE WPS - AITKIN CLI
MN623242600Medicaid
MN500003860OtherMEDICARE WPS - GARRISON C
MN500003859OtherMEDICARE WPS - MCGREGOR C
MN623242600Medicaid