Provider Demographics
NPI:1063483022
Name:FISHER, REBEKAH AUTUMN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:AUTUMN
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBEKAH
Other - Middle Name:AUTUMN
Other - Last Name:CADMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1936 LEXINGTON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-1048
Mailing Address - Country:US
Mailing Address - Phone:847-689-2196
Mailing Address - Fax:
Practice Address - Street 1:115 E 1ST ST
Practice Address - Street 2:SUITE 2W
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4280
Practice Address - Country:US
Practice Address - Phone:630-734-0580
Practice Address - Fax:630-734-0581
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1067215OtherNCCPA CERT (NATIONAL)