Basic Information
| Provider Information | |||||||||
| NPI: | 1457415069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'ROURKE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHEITERLE | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | JACKSON | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4919 W CRAIG RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891302730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7252208706 | ||||||||
| FaxNumber: | 8337490366 | ||||||||
| Practice Location | |||||||||
| Address1: | 4919 W CRAIG RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891302730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7252208706 | ||||||||
| FaxNumber: | 8337490366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18026 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine | 174400000X | MD16304 | HI | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 694803 | 05 | HI | MEDICAID | 18026 | 01 | NV | NV STATE LICENSE | OTHER | 1457415069 | 05 | NV | MEDICAID |