Provider Demographics
NPI:1144277724
Name:SOUZA, REBECCA S (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3787
Mailing Address - Country:US
Mailing Address - Phone:425-317-9119
Mailing Address - Fax:
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3787
Practice Address - Country:US
Practice Address - Phone:425-317-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8394785Medicaid
WAPA10004607OtherSTATE LICENSE NUMBER
WA0181108OtherLABOR AND INDUSTRY
WAP00162972OtherRAILROAD MEDICARE
WA0181108OtherLABOR AND INDUSTRY
WAP00162972OtherRAILROAD MEDICARE