Individual
MISS REBECCA D CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
382 N OVERLAND AVE, BURLEY, ID 83318-3433
(208) 678-6996
Mailing address
9040 A JACKSON AVE, JOINT BASE LEWIS MCCHORD, WA 98431-0001
(253) 968-1484
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
60491889
WA
363A00000X
Physician Assistant
Primary
PA-1911
ID
Other
Enumeration date
11/06/2013
Last updated
11/18/2021
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