Provider Demographics
NPI:1164878542
Name:WAGSCHAL, REBECCA (ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WAGSCHAL
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:KLEINOW-WAGSCHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, CNM
Mailing Address - Street 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-324-4160
Practice Address - Street 1:1510 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2463
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-324-4160
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-129554176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid
IAPENDINGMedicaid
IAPENDINGMedicaid