Healthcare Provider Details

I. General information

NPI: 1568959203
Provider Name (Legal Business Name): REBEKAH SHEA WIELAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 INTERNATIONAL WAY
SPRINGFIELD OR
97477-1047
US

IV. Provider business mailing address

PO BOX 72059
SPRINGFIELD OR
97475-0285
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6914
  • Fax: 541-326-0924
Mailing address:
  • Phone: 541-222-6915
  • Fax: 541-326-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD220278
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD220278
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD220278
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: