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Individual

REBEKAH KOTTKAMP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 400-4550
(574) 400-4551
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004841A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000870047
BCBS BMGSOUTHEAST
IN
01
000000870050
BCBS BMG CENTENNIAL
IN
01
000000872005
BCBS BMG CENTRAL
IN
01
178410010
MEDICARE PTAN
IN
01
178420011
MEDICARE PTAN
IN
05
201220670
IN
01
P01413900
RR MEDICARE
IN
Enumeration date
02/12/2014
Last updated
01/29/2019
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