Individual
MISS REBEKAH J BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 535-4130
(208) 535-4125
Mailing address
P O BOX 1647, 3100 CHANNING WAY, IDAHO FALLS, ID 83404-1647
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-700
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345
ALL PENDING
—
Enumeration date
10/10/2007
Last updated
10/10/2007
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