Provider Demographics
NPI:1427145036
Name:HINTZE, REBECCA (PAC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HINTZE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2624
Mailing Address - Country:US
Mailing Address - Phone:406-922-0871
Mailing Address - Fax:406-823-6305
Practice Address - Street 1:126 S MAIN ST
Practice Address - Street 2:COMMUNITY HEALTH PARTNERS
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-1111
Practice Address - Fax:406-823-6305
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT306119Medicaid