Provider Demographics
NPI:1043417686
Name:SIENKO, REBECCA MARIE (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:SIENKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:525 S LAKE AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2300
Mailing Address - Country:US
Mailing Address - Phone:218-740-2320
Mailing Address - Fax:
Practice Address - Street 1:525 S LAKE AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2300
Practice Address - Country:US
Practice Address - Phone:218-740-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 096045-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse