Healthcare Provider Details

I. General information

NPI: 1669971958
Provider Name (Legal Business Name): REBEKAH MILLER STOVALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 HEALTH CAMPUS DRIVE
HARRISONBURG VA
22801
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 540-689-1110
  • Fax: 549-689-1119
Mailing address:
  • Phone: 540-564-7084
  • Fax: 540-564-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006064
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: