Provider Demographics
NPI:1982433553
Name:REHBERG, REBECCA ANN (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:REHBERG
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3318
Mailing Address - Country:US
Mailing Address - Phone:734-718-1912
Mailing Address - Fax:
Practice Address - Street 1:9180 MARIE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3318
Practice Address - Country:US
Practice Address - Phone:734-718-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290474363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care