Provider Demographics
NPI:1356801385
Name:SHULTZ, REBEKAH SHARLENE (RN, CNM)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:SHARLENE
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:MISS
Other - First Name:REBEKAH
Other - Middle Name:SHARLENE
Other - Last Name:EUSTACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:115 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4781
Mailing Address - Country:US
Mailing Address - Phone:903-723-8554
Mailing Address - Fax:903-723-2054
Practice Address - Street 1:116 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4780
Practice Address - Country:US
Practice Address - Phone:903-723-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP108374367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife