Basic Information
Provider Information
NPI: 1255824009
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEARCE
FirstName: REBECCA
MiddleName: ALLISON
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2458 KENWOOD BLVD LOWR UNIT
Address2:  
City: TOLEDO
State: OH
PostalCode: 436063729
CountryCode: US
TelephoneNumber: 4693235359
FaxNumber:  
Practice Location
Address1: 718 N MACOMB ST
Address2:  
City: MONROE
State: MI
PostalCode: 481627815
CountryCode: US
TelephoneNumber: 7342408400
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2018
LastUpdateDate: 09/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X5101024027MIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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