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NPI Code Detail

MEDICARE: MRS. REBECCA LYNN MARTIN PA-C

MEDICARE: MRS. REBECCA LYNN MARTIN PA-C
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
1363A00000XPhysician Assistant085003480IL

General Provider Information

NPI Number : 1841429495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA LYNN MARTIN PA-C
Provider Business Mailing Address
First Line : 176 W MOUND RD
Second Line :
City : DECATUR
State : IL
Zip : 62526-1964
Country : US
Telephone Number : 217-875-0163
Fax Number :
Provider Business Practice Location Address
First Line : 176 W MOUND RD
Second Line :
City : DECATUR
State : IL
Zip : 62526-1964
Country : US
Telephone Number : 217-875-0163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2009
Last Update Date : 01/06/2022

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