Provider Demographics
NPI:1760911499
Name:TEETZ, REBECCA MARIE (BA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARIE
Last Name:TEETZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4771 E CRAIG RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2572
Mailing Address - Country:US
Mailing Address - Phone:7027-433-8447
Mailing Address - Fax:
Practice Address - Street 1:4771 E CRAIG RD UNIT C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2572
Practice Address - Country:US
Practice Address - Phone:7027-433-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator