Healthcare Provider Details

I. General information

NPI: 1780426387
Provider Name (Legal Business Name): REBECCA SCHULTHEIS SURGICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CONCERT DR
VIRGINIA BEACH VA
23456-8082
US

IV. Provider business mailing address

2133 BATTERY PARK RD
CHESAPEAKE VA
23323-5050
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-2937
  • Fax:
Mailing address:
  • Phone: 757-202-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: