Provider Demographics
NPI:1487942512
Name:SEDERWALL, BECKY M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:M
Last Name:SEDERWALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:M
Other - Last Name:WOOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:565 COAL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3703
Mailing Address - Country:US
Mailing Address - Phone:412-267-6810
Mailing Address - Fax:
Practice Address - Street 1:565 COAL VALLEY RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3703
Practice Address - Country:US
Practice Address - Phone:412-267-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054913363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical