Provider Demographics
NPI:1841434313
Name:CHITTENDEN, REBECCA L (PA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:CHITTENDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1753 W RIDGEWAY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4544
Mailing Address - Country:US
Mailing Address - Phone:319-833-5888
Mailing Address - Fax:319-833-5891
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4544
Practice Address - Country:US
Practice Address - Phone:319-833-5888
Practice Address - Fax:319-833-5891
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-10-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00751366OtherRR MEDICARE
IAP00751366OtherRR MEDICARE