Provider Demographics
NPI:1750034658
Name:AMBELANG, REBECCA (PN1, PN2)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:AMBELANG
Suffix:
Gender:F
Credentials:PN1, PN2
Other - Prefix:MRS
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:RECKMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1516 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1516 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5403
Practice Address - Country:US
Practice Address - Phone:210-452-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date: