Individual
REBECCA LYNN MITTELSTADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2709 LEGENDS PKWY, PRATTVILLE, AL 36066-7755
(334) 310-1117
Mailing address
2709 LEGENDS PKWY, PRATTVILLE, AL 36066-7755
(334) 310-1117
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA405
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51000413
BLUE CROSS/BLUE SHIELD
AL
Enumeration date
03/03/2006
Last updated
09/24/2020
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