Provider Demographics
NPI:1245609742
Name:LA ROCK, REBECCA A (PAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:LA ROCK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:MICHALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1260 SENTRY DR
Mailing Address - Street 2:STE 140
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5990
Mailing Address - Country:US
Mailing Address - Phone:262-524-1024
Mailing Address - Fax:262-524-8767
Practice Address - Street 1:1111 DELAFIELD STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-544-4411
Practice Address - Fax:262-650-3856
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant