Individual
REBECCA LYNN BOURBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
4005 HIGH RESORT BLVD SE, RIO RANCHO, NM 87124-5906
(505) 462-6000
(505) 462-8472
Mailing address
PO BOX 26666, PRESBYTERIAN HEALTHCARE SERVICES, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
92-PA09
NM
363AM0700X
Medical Physician Assistant
92-PA09
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA920091
—
NM
Enumeration date
01/03/2007
Last updated
09/10/2015
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