Provider Demographics
NPI:1720673601
Name:SPONSELLER, REBEKAH RUTH (PA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:RUTH
Last Name:SPONSELLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:RUTH
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3113 COMMERCE PL APT I
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5163
Mailing Address - Country:US
Mailing Address - Phone:810-287-8472
Mailing Address - Fax:
Practice Address - Street 1:3113 COMMERCE PL APT I
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5163
Practice Address - Country:US
Practice Address - Phone:810-287-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant