| Doctor Name: | REBECCA LYNN BOURBON |
| NPI Number: | 1003973231 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.-C |
| License Number: | 92-PA09 |
| Business Practice Address: | 4005 High Resort Blvd Se Rio Rancho, NM - 871245906 |
| Business Phone Number: | 5054626000 |
| Business Fax Number: | 5054628472 |
| Mailing Address: | Po Box 26666, Presbyterian Healthcare Services ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871256666 |
| Phone Number: | 5059236770 |
| Fax Number: | |
| NPI Enumeration Date: | 01/03/2007 |
| NPI Last Update Date: | 09/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 92-PA09 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |