Provider Demographics
NPI:1659049120
Name:EKEMA, REBEKAH NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:NICOLE
Last Name:EKEMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:NICOLE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1199 COLONIAL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1900
Practice Address - Country:US
Practice Address - Phone:717-652-8436
Practice Address - Fax:717-652-8804
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062836363A00000X
PAOA005812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1W5221OtherMEDICARE PTAN
PA1039706280001Medicaid