| NPI | 1033001326 |
|---|---|
| Former Name | REBECCA ICKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 8271687) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 62984) |
| Enumeration Date | 2025-07-19 |
| Last Update Date | 2025-10-21 |