Provider Demographics
NPI:1518241157
Name:HAINES, REBECCA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:HAINES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:ROCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6797
Mailing Address - Country:US
Mailing Address - Phone:814-231-7153
Mailing Address - Fax:814-231-7894
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6797
Practice Address - Country:US
Practice Address - Phone:814-231-7153
Practice Address - Fax:814-231-7894
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055042363A00000X
PAOA002767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant