Mary Rebecca Rylance, PA
Individual provider Active NPI Physician Assistant · T Or C, NM
NPI 1205979622 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205979622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 92-PA06 (NM)
- Practice address
- 992 S Broadway St
T Or C, NM 87901-3198 - Phone
- (505) 894-4275
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 92-PA06 | NM | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 92-PA06 | NM | Yes |
Addresses
Primary practice location
992 S Broadway St
T Or C, NM 87901-3198
Mailing address
992 S Broadway St
T Or C, NM 87901-3198
Phone (505) 894-4275
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92PA06 | Other | NM | PA CERTIFICATE |
Other providers in T Or C, NM
- Myrna L Policarpio
- Ashleigh Pratt
- Carol Renninger
- Darlene Rouse
- Rustic Health LLC
- Haruhauani Spruce
- Frank Torrez Jr.
- Sheyla Velez
- Jim Vigil
- Debbie Whitehead
All providers in T Or C, NM · Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.