Provider Demographics
NPI:1093352791
Name:EVANS, REBECCA NOELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:NOELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5183
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-0183
Mailing Address - Country:US
Mailing Address - Phone:775-453-0351
Mailing Address - Fax:
Practice Address - Street 1:2885 CHURN CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1147
Practice Address - Country:US
Practice Address - Phone:530-221-6303
Practice Address - Fax:530-226-6329
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant