Basic Information
Provider Information
NPI: 1962928713
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUSTIN
FirstName: REBECCA
MiddleName: CLAIRE
NamePrefix:  
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 99 ASCENSION DR APT D109
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288061977
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 123 HENDERSONVILLE RD
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288032868
CountryCode: US
TelephoneNumber: 8282574730
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/14/2017
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835P2201X26120NCY    

No ID Information.


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