Healthcare Provider Details

I. General information

NPI: 1215106877
Provider Name (Legal Business Name): REBECCA HOWARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 RIVERBEND DR STE 500
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

3355 RIVERBEND DR STE 500
SPRINGFIELD OR
97477-8800
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-9500
  • Fax: 541-685-5920
Mailing address:
  • Phone: 541-868-9500
  • Fax: 541-685-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA208737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: