| NPI | 1174762405 |
|---|---|
| Former Name | REBECCA KAY TIELKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NE 111229) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2014-07-15 |