Provider Demographics
NPI:1982780110
Name:RUNDLETT, REBECCA S (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:RUNDLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17134207RC0000X, 207R00000X
KS04-30389207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072500Medicaid
NE47070592301Medicaid
IA0537076Medicaid
NE10026072400Medicaid
NE47070592302Medicaid
NE10026072200Medicaid
NE10026072600Medicaid
NE47070592305Medicaid
NE47070592306Medicaid
NE47070592313Medicaid
NE10026072300Medicaid
KS100295920AMedicaid
OH2454893Medicaid
NE47070592300Medicaid
NE10026072000Medicaid
NE10026072500Medicaid
NE47070592306Medicaid
NE10026072000Medicaid
NE060034665Medicare PIN
NE47070592313Medicaid
NENA1939038Medicare PIN
KSKA2283001Medicare PIN
NE10026072600Medicaid
NE47070592302Medicaid
NE268240Medicare PIN