Healthcare Provider Details

I. General information

NPI: 1548484876
Provider Name (Legal Business Name): REBECCA S MCDOWELL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 14TH AVE SE
CEDAR RAPIDS IA
52401-2610
US

IV. Provider business mailing address

2550 GLASS RD NE
CEDAR RAPIDS IA
52402-7627
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-1626
  • Fax:
Mailing address:
  • Phone: 319-286-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000955
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: