Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 2592-033 | WI |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2592-33 | WI |
NPI | 1033259726 |
---|---|
Provider Name | Mrs. Rebecca Lynn Trewyn |
First Address | Juneau, WI 53039-4014 |
Second Address | Portage, WI 53901-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 10/02/2017 |