Provider Demographics
NPI:1982157301
Name:HOSMAN, REBEKAH MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:MICHELLE
Last Name:HOSMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBEKAH
Other - Middle Name:MICHELLE
Other - Last Name:HALLERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:45 E 400 S APT 5
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-4675
Mailing Address - Country:US
Mailing Address - Phone:805-637-5992
Mailing Address - Fax:
Practice Address - Street 1:3650 N UNIVERSITY AVE
Practice Address - Street 2:#200
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6656
Practice Address - Country:US
Practice Address - Phone:801-375-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9847199-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical