Healthcare Provider Details

I. General information

NPI: 1376665075
Provider Name (Legal Business Name): REBECCA SUE ROWEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 01/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N 3RD ST
PHOENIX AZ
85004-1401
US

IV. Provider business mailing address

3133 E CAMELBACK RD STE 105
PHOENIX AZ
85016-4545
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6634
  • Fax: 602-258-4311
Mailing address:
  • Phone: 602-522-1900
  • Fax: 602-381-3281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3600
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: