Provider Demographics
NPI:1306232079
Name:STRUNK-LAIL, REBECCA LEE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LEE
Last Name:STRUNK-LAIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1611
Mailing Address - Country:US
Mailing Address - Phone:434-774-4144
Mailing Address - Fax:
Practice Address - Street 1:1211 N. COMMUNITY HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-544-8200
Practice Address - Fax:704-544-8300
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05677363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical