Provider Demographics
NPI:1487016127
Name:VIGEANT, REBECCA LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNNE
Last Name:VIGEANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LYNNE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 WASHINGTON STREET
Mailing Address - Street 2:SOUTH BUILDING, MEZZANINE FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6317
Mailing Address - Fax:617-636-5349
Practice Address - Street 1:800 WASHINGTON STREET
Practice Address - Street 2:SOUTH BUILDING, MEZZANINE FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6317
Practice Address - Fax:617-636-5349
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA5689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant