Provider Demographics
NPI:1083100986
Name:COLEMAN, REBEKA LYN (PA)
Entity Type:Individual
Prefix:
First Name:REBEKA
Middle Name:LYN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:4468 S ENCLAVE LN
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1625
Practice Address - Country:US
Practice Address - Phone:808-242-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2021-11-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant