Healthcare Provider Details

I. General information

NPI: 1740226620
Provider Name (Legal Business Name): RENEE STECKLEY SPEIR RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE ELIZABETH STECKLEY PA

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8108 MARKET ST
WILMINGTON NC
28411-9386
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-1540
  • Fax:
Mailing address:
  • Phone: 910-341-1540
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001013604
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010597
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0050030655
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: