Individual
REBECCA L. PESTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
920 SW RANGE DR, WALDPORT, OR 97394-9634
(541) 563-3197
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA213386
OR
363AM0700X
Medical Physician Assistant
PA23236
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000097163
BCBS PIN
MT
01
—
4308684
MDCD PIN
MT
Enumeration date
07/20/2006
Last updated
08/14/2024
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