Provider Demographics
NPI:1568090769
Name:SCHNEIDER, REBECCA RUTH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RUTH
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:636 WILD HORSE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2049
Mailing Address - Country:US
Mailing Address - Phone:618-319-2432
Mailing Address - Fax:
Practice Address - Street 1:607 S NEW BALLAS RD STE 2350
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-0001
Practice Address - Country:US
Practice Address - Phone:314-251-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085007387363A00000X
MO2020007081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant