Basic Information
| Provider Information | |||||||||
| NPI: | 1730159328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAY | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BUNKER HILL DR | ||||||||
| Address2: | |||||||||
| City: | AITKIN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564311865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189272157 | ||||||||
| FaxNumber: | 2189274130 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BUNKER HILL DR | ||||||||
| Address2: | |||||||||
| City: | AITKIN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564311865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189272157 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R0802842 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 500003858 | 01 | MN | MEDICARE WPS HOSPITAL | OTHER | 500000267 | 01 | MN | MEDICARE WPS - AITKIN CLI | OTHER | 623242600 | 05 | MN | MEDICAID | 500003860 | 01 | MN | MEDICARE WPS - GARRISON C | OTHER | 500003859 | 01 | MN | MEDICARE WPS - MCGREGOR C | OTHER |