Provider Demographics
NPI:1821843525
Name:WOLSTEIN, REBECCA LEE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:WOLSTEIN
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 1:4560 LANTANA RD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6998
Mailing Address - Country:US
Mailing Address - Phone:914-960-9597
Mailing Address - Fax:
Practice Address - Street 1:3319 S STATE ROAD 7 STE 313
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8147
Practice Address - Country:US
Practice Address - Phone:561-433-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant