Individual
RENEE IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R136666-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178453600
—
MN
05
—
36085500
—
WI
01
—
500016893
RAILROAD MEDICARE
MN
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
12/29/2005
Last updated
11/27/2023
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