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Individual

REBECCA MARIE SHELTON EVANGELISTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2608 ERWIN RD, STE 200, DURHAM, NC 27705-4596
(919) 684-2595
Mailing address
2608 ERWIN RD, STE 200, DURHAM, NC 27705-4596
(919) 684-2595

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001002526
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001002526
STATE LICENSE
NC
Enumeration date
01/18/2011
Last updated
02/15/2017
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