Provider Demographics
NPI:1750578647
Name:REPPUHN, REBECCA ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:REPPUHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SOUTH BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3163
Mailing Address - Country:US
Mailing Address - Phone:248-206-1200
Mailing Address - Fax:248-206-1206
Practice Address - Street 1:585 SOUTH BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3163
Practice Address - Country:US
Practice Address - Phone:248-206-1200
Practice Address - Fax:248-206-1206
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003604363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ08760Medicare UPIN
MION8791002Medicare PIN