Provider Demographics
NPI:1003535162
Name:MCCONEGHY, REBECCA CLAIR-JEWELL
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIR-JEWELL
Last Name:MCCONEGHY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGCNS-BC
Mailing Address - Street 1:14325 HYLAND DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2313
Mailing Address - Country:US
Mailing Address - Phone:414-218-2040
Mailing Address - Fax:
Practice Address - Street 1:14325 HYLAND DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2313
Practice Address - Country:US
Practice Address - Phone:414-218-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI198445-30364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist