Healthcare Provider Details

I. General information

NPI: 1447573126
Provider Name (Legal Business Name): REBECCA L. PRICE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA L CHURCH PA-C

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 RUSH ST
PETOSKEY MI
49770-2920
US

IV. Provider business mailing address

560 W MITCHELL ST STE 500
PETOSKEY MI
49770-2277
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-5511
  • Fax:
Mailing address:
  • Phone: 231-487-2100
  • Fax: 231-487-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005724
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4704260468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: