Bourbon, Rebecca Lynn
Bourbon, Rebecca Lynn is an individual health care provider with primary practice located at 4005 High Resort Blvd Se , Rio Rancho NM 87124-5906. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Bourbon, Rebecca Lynn can be contacted via phone (505) 462-6000.Contact Information
Primary practice address
4005 High Resort Blvd Se
Rio Rancho NM 87124-5906
Phone: (505) 462-6000
Fax: (505) 462-8472
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 92-PA09 | New Mexico |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 92-PA09 | New Mexico |
Profile Details
| NPI number | 1003973231 |
|---|---|
| LBN Legal business name | Bourbon, Rebecca Lynn |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 3rd, 2007 |
| Last updated | Sep 10th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003973231 | NPPES |
| New Mexico | MEDICAID | PA920091 |
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