Healthcare Provider Details

I. General information

NPI: 1982314977
Provider Name (Legal Business Name): REBECCA ALEXANDRA CUTLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ELM LN STE 102
CHARLOTTE NC
28277-0716
US

IV. Provider business mailing address

2520 SOUTH BLVD APT 526
CHARLOTTE NC
28203-6661
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001012738
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: