Individual
MRS. REBECCA IVRY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
201 3RD AVE, SUITE 201, SEWARD, AK 99664
(907) 224-4916
(907) 224-5870
Mailing address
PO BOX 3262, SEWARD, AK 99664-3262
(907) 224-4916
(907) 224-5870
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
19315
CA
363A00000X
Physician Assistant
Primary
PAD A 830
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA19315
—
CA
Enumeration date
09/07/2007
Last updated
01/13/2009
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