Provider Demographics
NPI:1972198885
Name:ADMIRE, REBECCA MARIE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:ADMIRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WOODBURN DR
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2814
Mailing Address - Country:US
Mailing Address - Phone:305-479-7766
Mailing Address - Fax:
Practice Address - Street 1:1660 FEEHANVILLE DR STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6036
Practice Address - Country:US
Practice Address - Phone:847-823-3185
Practice Address - Fax:847-823-3318
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA9288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant