MEDICARE: REBECCA LEE WOLSTEIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9118736	FL

General Provider Information

NPI Number	:	1821843525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LEE WOLSTEIN PA-C

Provider Business Mailing Address
First Line	:	4560 LANTANA RD UNIT 120
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6998
Country	:	US
Telephone Number	:	914-960-9597
Fax Number	:

Provider Business Practice Location Address
First Line	:	3319 S STATE ROAD 7 STE 313
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8147
Country	:	US
Telephone Number	:	561-433-4444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	06/08/2024

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