Healthcare Provider Details

I. General information

NPI: 1013811462
Provider Name (Legal Business Name): MEGAN ELIZABETH REBHOLZ MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 W AMERICAN DR STE 100
NEENAH WI
54956-1405
US

IV. Provider business mailing address

202 ERIN CT
WEST BEND WI
53095-5345
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-8979
  • Fax: 920-886-2225
Mailing address:
  • Phone: 262-343-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9021-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: