Provider Demographics
NPI:1932542305
Name:JUNGERS, REBECCA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:JUNGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19425 EVANS ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1074
Mailing Address - Country:US
Mailing Address - Phone:763-398-7686
Mailing Address - Fax:763-241-8404
Practice Address - Street 1:19425 EVANS ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1074
Practice Address - Country:US
Practice Address - Phone:763-398-7686
Practice Address - Fax:763-241-8404
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant