Provider Demographics
NPI:1902523368
Name:WYATT, REBECCA HOSHI (APNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HOSHI
Last Name:WYATT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 ALLIED ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5541
Mailing Address - Country:US
Mailing Address - Phone:920-351-1675
Mailing Address - Fax:
Practice Address - Street 1:2960 ALLIED ST STE 101
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5542
Practice Address - Country:US
Practice Address - Phone:920-351-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13257-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology