Provider Demographics
NPI:1447641717
Name:NORDIN, REBECCA (RNFA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NORDIN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:REBA
Other - Middle Name:
Other - Last Name:VAN KOOTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1909 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5530
Mailing Address - Country:US
Mailing Address - Phone:307-745-8851
Mailing Address - Fax:
Practice Address - Street 1:1909 VISTA DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5530
Practice Address - Country:US
Practice Address - Phone:307-745-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY30868163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant