Provider Demographics
NPI:1174058226
Name:RIEDELL, REBECCA (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RIEDELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DIKEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13421 95TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5656
Mailing Address - Country:US
Mailing Address - Phone:253-365-3435
Mailing Address - Fax:253-896-1123
Practice Address - Street 1:13421 95TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5656
Practice Address - Country:US
Practice Address - Phone:253-365-3435
Practice Address - Fax:253-896-1123
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00137736171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator