Provider Demographics
NPI:1467428151
Name:LAMCZIK, REBECCA ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:LAMCZIK
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 1:54 E STEIN RD
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:IL
Mailing Address - Zip Code:62994-1108
Mailing Address - Country:US
Mailing Address - Phone:618-426-1141
Mailing Address - Fax:
Practice Address - Street 1:1 DOCTORS PARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6291
Practice Address - Country:US
Practice Address - Phone:618-246-2910
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S78396Medicare UPIN