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General NPI Number Information
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NPI Number | 1104019264
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Entity Type | Individual
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Provider Name | REBECCA L. HISSONG PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 22 ST PAUL DRIVE SUITE 202
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-1036
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Country | US
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Telephone | 717-217-6870
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Fax | 717-217-6945
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Provider Business Mailing Address
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Address Line | 785 5TH AVE SUITE 3
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-4232
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Country | US
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Telephone | 717-263-9555
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Fax | 717-217-4218
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA001865L
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License Number State | PA
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