Provider Demographics
NPI:1972021210
Name:HEIM, REBECCA D (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:HEIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 HOSPITAL DR LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2160
Mailing Address - Country:US
Mailing Address - Phone:724-912-6277
Mailing Address - Fax:
Practice Address - Street 1:2360 HOSPITAL DR LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2160
Practice Address - Country:US
Practice Address - Phone:724-912-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-10-16
Deactivation Date:2023-10-12
Deactivation Code:
Reactivation Date:2023-10-16
Provider Licenses
StateLicense IDTaxonomies
PAMA059232363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA059232OtherSTATE LICENSE