=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013811462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN ELIZABETH REBHOLZ MPAS, PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1265 W AMERICAN DR STE 100
-----------------------------------------------------
City | NEENAH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54956-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-886-8979
-----------------------------------------------------
Fax | 920-886-2225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 ERIN CT
-----------------------------------------------------
City | WEST BEND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53095-5345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-343-0458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 9021-23
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------