Provider Demographics
NPI:1528507266
Name:UNGER, REBECCA DIANE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:UNGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DIANE
Other - Last Name:UNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-4756
Practice Address - Street 1:11009 INGLESIDE PL STE 303
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6697
Practice Address - Country:US
Practice Address - Phone:919-341-3603
Practice Address - Fax:919-341-3610
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant