Provider Demographics
NPI:1497754634
Name:RIEPSHOFF, REBECCA SUE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:RIEPSHOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:THREE SAINT ELIZABETH BLVD STE 2800
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1282
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:833-973-4218
Practice Address - Street 1:THREE SAINT ELIZABETH BLVD STE 2800
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1282
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:833-973-4218
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.001704207RC0001X, 363A00000X
MO2006028761363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000097403Medicaid
MOP00391603Medicare PIN
MO000097403Medicaid