Healthcare Provider Details

I. General information

NPI: 1003328337
Provider Name (Legal Business Name): REBECCA AMBER MORISSETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
AGAWAM MA
01001-1838
US

IV. Provider business mailing address

230 MAIN ST
AGAWAM MA
01001-1838
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA6319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: