Basic Information
| Provider Information | |||||||||
| NPI: | 1568798700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERTISH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | CERTIFIED FAMILY NUR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 CENTRACARE CIRCLE, #2300 | ||||||||
| Address2: | CENTRACARE CLINIC WOMEN'S & CHILDRENS/OB0GYN | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543630 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 CENTRACARE CIRCLE, #2300 | ||||||||
| Address2: | CENTRACARE CLINIC WOMEN'S & CHILDRENS/OB0GYN | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543630 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R-137104-2 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.