Healthcare Provider Details

I. General information

NPI: 1083279392
Provider Name (Legal Business Name): REBECCA STOLORENA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 08/12/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 S NC 16 BUSINESS HWY
DENVER NC
28037-9319
US

IV. Provider business mailing address

6127 S HWY 16
DENVER NC
28037
US

V. Phone/Fax

Practice location:
  • Phone: 704-483-0340
  • Fax: 704-483-8217
Mailing address:
  • Phone: 704-483-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0010-09200
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: