Provider Demographics
NPI:1295741254
Name:REPAIRE, REBECCA LINDLEY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LINDLEY
Last Name:REPAIRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LINDLEY
Other - Last Name:FUHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:912 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4175
Mailing Address - Country:US
Mailing Address - Phone:843-216-3530
Mailing Address - Fax:877-896-6449
Practice Address - Street 1:912 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-216-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant