Provider Demographics
NPI:1205991916
Name:REVEAL, REBECCA C (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:REVEAL
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:541-463-2820
Practice Address - Street 1:2000 N 19TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2526
Practice Address - Country:US
Practice Address - Phone:541-746-5437
Practice Address - Fax:541-746-3753
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1458363AM0700X
ORPA182393363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical