Provider Demographics
NPI:1386850766
Name:ALTON, REBECCA LEED (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEED
Last Name:ALTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 PRAIRIE VIEW CIR APT G
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8485
Mailing Address - Country:US
Mailing Address - Phone:317-745-0524
Mailing Address - Fax:
Practice Address - Street 1:800 S LOCUST ST
Practice Address - Street 2:STE 100
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2052
Practice Address - Country:US
Practice Address - Phone:765-658-4555
Practice Address - Fax:765-658-4554
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000798A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant