Basic Information
| Provider Information | |||||||||
| NPI: | 1811012602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUCHON | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 LOUISIANA BLVD NE | ||||||||
| Address2: | SUITE #401 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871107022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052604300 | ||||||||
| FaxNumber: | 5052604371 | ||||||||
| Practice Location | |||||||||
| Address1: | 8300 CONSTITUTION AVE NE | ||||||||
| Address2: | KASEMAN HOSPITAL | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871107613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052912770 | ||||||||
| FaxNumber: | 5052912706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 81-PA016 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 363AM0700X | 81-PA016 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 93013 | 05 | NM | MEDICAID |