Healthcare Provider Details

I. General information

NPI: 1568090769
Provider Name (Legal Business Name): REBECCA RUTH SCHNEIDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S NEW BALLAS RD STE 2350
SAINT LOUIS MO
63141-0001
US

IV. Provider business mailing address

636 WILD HORSE CREEK DR
FAIRVIEW HEIGHTS IL
62208-2049
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-4260
  • Fax:
Mailing address:
  • Phone: 618-319-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085007387
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2020007081
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: