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General NPI Number Information
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NPI Number | 1962366740
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Entity Type | Individual
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Provider Name | REBECCA SHORTREED
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 1501 W MARKET ST STE 110
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City | MEQUON
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State | WI
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Zip | 53092-5053
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Country | US
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Telephone | 262-388-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 1975 FARMLANE DR
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City | SLINGER
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State | WI
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Zip | 53086-3003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 8127-403
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License Number State | WI
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