Provider Demographics
NPI:1679664379
Name:BLUME, REBECCA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:BLUME
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:18028 FOGEL RD
Mailing Address - Street 2:
Mailing Address - City:CHURUBUSCO
Mailing Address - State:IN
Mailing Address - Zip Code:46723-9213
Mailing Address - Country:US
Mailing Address - Phone:260-637-7537
Mailing Address - Fax:260-424-2551
Practice Address - Street 1:3030 LAKE AVE
Practice Address - Street 2:SUITE 25A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5428
Practice Address - Country:US
Practice Address - Phone:260-422-4096
Practice Address - Fax:260-424-2551
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN10000655A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant