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Individual

MRS. REBECCA LYNN CHILDERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
22711 S ELLSWORTH ROAD, SUITE 104, QUEEN CREEK, AZ 85142
(480) 782-0993
(833) 337-0386
Mailing address
530 E THOMAS ROAD, PHOENIX, AZ 85012-3204
(860) 678-3402
(844) 364-3181

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1293
NE
363A00000X
Physician Assistant
Primary
2760
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100250445-00
NE
Enumeration date
03/08/2007
Last updated
11/19/2021
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