Healthcare Provider Details

I. General information

NPI: 1437827797
Provider Name (Legal Business Name): REBECCA LEE HAMILTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LEE LONG

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27B TALISMAN DR UNIT 3
PAGOSA SPRINGS CO
81147-7914
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR UNIT 3
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-372-0456
  • Fax:
Mailing address:
  • Phone:
  • Fax: 970-335-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: