Provider Demographics
NPI:1114069382
Name:MOSBURG, REBECCA GENE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GENE
Last Name:MOSBURG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GENE
Other - Last Name:HUTCHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1773 W SAINT MARYS RD
Mailing Address - Street 2:STE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2654
Mailing Address - Country:US
Mailing Address - Phone:520-624-2194
Mailing Address - Fax:
Practice Address - Street 1:1773 W SAINT MARYS RD
Practice Address - Street 2:STE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2654
Practice Address - Country:US
Practice Address - Phone:520-624-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002458363A00000X
AZ4469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant