Provider Demographics
NPI:1851706436
Name:REDER, REBECCA DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DAWN
Last Name:REDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:DAWN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:410 9TH AVE N
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4708
Mailing Address - Country:US
Mailing Address - Phone:206-520-5000
Mailing Address - Fax:
Practice Address - Street 1:410 9TH AVE N
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4708
Practice Address - Country:US
Practice Address - Phone:206-520-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60455377363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8929034Medicare PIN