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NPI Code Detail

MEDICARE: REBECCA SHORTREED

MEDICARE: REBECCA SHORTREED
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
1174400000XSpecialist8127-403WI

General Provider Information

NPI Number : 1962366740
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA SHORTREED
Provider Business Mailing Address
First Line : 1975 FARMLANE DR
Second Line :
City : SLINGER
State : WI
Zip : 53086-3003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1501 W MARKET ST STE 110
Second Line :
City : MEQUON
State : WI
Zip : 53092-5053
Country : US
Telephone Number : 262-388-3666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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Directions to “ REBECCA SHORTREED ” Practice Location

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