Provider Demographics
NPI:1366138901
Name:WINQUIST, REBECCA LYNN (AGACNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:WINQUIST
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:LAHTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:1020 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-1922
Mailing Address - Country:US
Mailing Address - Phone:269-591-9488
Mailing Address - Fax:
Practice Address - Street 1:1020 N 17TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-1922
Practice Address - Country:US
Practice Address - Phone:269-591-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241144363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health