Healthcare Provider Details

I. General information

NPI: 1932010337
Provider Name (Legal Business Name): REBEKAH JAN BEATTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 15 MILE RD
STERLING HEIGHTS MI
48312-4511
US

IV. Provider business mailing address

7585 GANNON
SHELBY TOWNSHIP MI
48317-2239
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-6210
  • Fax:
Mailing address:
  • Phone: 586-218-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: