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NPI Code Detail

MEDICARE: REBECCA L. PESTLE PAC

MEDICARE: REBECCA L. PESTLE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA23236CA
2363A00000XPhysician AssistantPA213386OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000097163OTHERMTBCBS PIN
24308684OTHERMTMDCD PIN

General Provider Information

NPI Number : 1144240615
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA L. PESTLE PAC
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 920 SW RANGE DR
Second Line :
City : WALDPORT
State : OR
Zip : 97394-9634
Country : US
Telephone Number : 541-563-3197
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 08/14/2024

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Directions to “ REBECCA L. PESTLE PAC” Practice Location

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