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General NPI Number Information
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NPI Number | 1083279392
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Entity Type | Individual
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Provider Name | REBECCA STOLORENA PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 6127 S NC 16 BUSINESS HWY
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City | DENVER
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State | NC
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Zip | 28037-9319
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Country | US
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Telephone | 704-483-0340
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Fax | 704-483-8217
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Provider Business Mailing Address
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Address Line | 6127 S HWY 16
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City | DENVER
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State | NC
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Zip | 28037
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Country | US
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Telephone | 704-483-0340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0010-09200
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License Number State | NC
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