Provider Demographics
NPI:1508222308
Name:SCHETTLE, REBECCA A (APNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:SCHETTLE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1109
Mailing Address - Country:US
Mailing Address - Phone:414-462-2373
Mailing Address - Fax:414-462-2393
Practice Address - Street 1:10800 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-462-2373
Practice Address - Fax:414-462-2393
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508222308Medicaid
WI1508222308Medicaid