| Doctor Name: | REBECCA IRENE ROGHOLT |
| NPI Number: | 1346543725 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, RN, CNS |
| License Number: | R147800-0 |
| Business Practice Address: | 1406 6th Avenue North St. Cloud Hospital St. Cloud, MN - 563031901 |
| Business Phone Number: | 3202512700 |
| Business Fax Number: | 3202295109 |
| Mailing Address: | 1900 Centracare Circle #2475, Centracare Health Plaza ST. CLOUD |
| State: | MN |
| Postal Code: | 56303 |
| Phone Number: | 3202295199 |
| Fax Number: | 3202295109 |
| NPI Enumeration Date: | 12/07/2010 |
| NPI Last Update Date: | 12/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0808X |
| License Number: | R147800-0 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |