Provider Demographics
NPI:1487060588
Name:WRIGHT, REBECCA R (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:R
Other - Last Name:CABRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5615 YORK RD
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-9553
Mailing Address - Country:US
Mailing Address - Phone:717-624-1337
Mailing Address - Fax:717-624-1795
Practice Address - Street 1:5615 YORK RD
Practice Address - Street 2:HANOVER HEALTH CORPORATION
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9553
Practice Address - Country:US
Practice Address - Phone:717-624-1337
Practice Address - Fax:717-624-1795
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056959363A00000X
PAOA003333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50127114OtherCAPITAL BC
PA361952ZEA5Medicare PIN
PA50127114OtherCAPITAL BC