Provider Demographics
NPI:1043209968
Name:SCHULTZ, REBECCA A (NP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6936
Mailing Address - Fax:414-385-1599
Practice Address - Street 1:1020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1308
Practice Address - Country:US
Practice Address - Phone:414-647-6936
Practice Address - Fax:414-385-1599
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI702363L00000X
WI978982-030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43844100Medicaid
WI737190036Medicare ID - Type Unspecified
WI43844100Medicaid