Provider Demographics
NPI:1760204036
Name:TRAUGOTT, REBECCA LYNNE (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:TRAUGOTT
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-5310
Mailing Address - Country:US
Mailing Address - Phone:870-370-0838
Mailing Address - Fax:
Practice Address - Street 1:510 E BRADLEY ST
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-5310
Practice Address - Country:US
Practice Address - Phone:870-370-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR30357163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant