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General NPI Number Information
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NPI Number | 1558836650
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Entity Type | Individual
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Provider Name | REBECCA RAE MAHN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 1700 CLINTON ST
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City | MUSKEGON
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State | MI
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Zip | 49442-5502
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Country | US
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Telephone | 231-728-4601
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Fax | 231-728-5777
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Provider Business Mailing Address
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Address Line | 6250 HEIGHTS RAVENNA RD
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City | FRUITPORT
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State | MI
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Zip | 49415-8697
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Country | US
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Telephone | 231-742-1983
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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 | 5601008867
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License Number State | MI
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