Healthcare Provider Details

I. General information

NPI: 1952559072
Provider Name (Legal Business Name): REBECCA ANN GROSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN WEAVER PA-C

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 WESTBRANCH HWY STE 1000
LEWISBURG PA
17837-6864
US

IV. Provider business mailing address

1 HOSPITAL DR SUITE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-3006
  • Fax: 570-523-0404
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053522
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: