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Rebecca Michelle Penner

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

100 E Idaho St Ste 200, Boise, ID 83712-6270

PECOS Enrollment

This provider is enrolled in PECOS as REBECCA PENNER.

Based on the most recent information from CMS, provider Rebecca Michelle Penner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1932765013
Provider Type
Individual
Full Name
Penner, Rebecca Michelle
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
5/14/2019
Last Updated
12/20/2023

Contact Information

Practice Location

100 E Idaho St Ste 200, Boise, ID 83712-6270

(208) 381-2711

(208) 381-4847

Mailing Location

190 E Bannock St, Boise, ID 83712-6241

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA-1665 Idaho
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Rebecca Michelle Penner

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Cole-Riccardi, Michelle Denise

Ricci, Christina E

Schram, Susan Marie

Shearing, Kevin Scott

Meziere, Lauren

Riggs, Rodney

Davis, Brittney

Apreotesi, Angela

Manko, Marc

Box, Nicholas J