Provider Demographics
NPI:1164218400
Name:SCHULTZ, REBECCA JEAN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:SCHULTZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-2111
Mailing Address - Country:US
Mailing Address - Phone:586-480-8821
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST # 9C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program