Provider Demographics
NPI:1962907097
Name:SWANBURG, REBECCA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:SWANBURG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:BRUBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATHLETIC TRAINER
Mailing Address - Street 1:629 SOUTHWICK PL
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-0670
Mailing Address - Country:US
Mailing Address - Phone:717-419-4942
Mailing Address - Fax:
Practice Address - Street 1:5601 ARRINGDON PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5677
Practice Address - Country:US
Practice Address - Phone:919-660-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101813532255A2300X
NC0010-12933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-12933OtherMEDICAL LICENSE