Provider Demographics
NPI:1023180007
Name:RENSCHLER, NICHOLE MICHELLE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MICHELLE
Last Name:RENSCHLER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:M
Other - Last Name:MACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:885-771-0335
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD STE 114
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7902
Practice Address - Country:US
Practice Address - Phone:916-887-7940
Practice Address - Fax:916-887-4045
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15389207RC0000X
CA15389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA970013594OtherRAILROAD MEDICARE
CAGR0068230Medicaid
CAGR0068231Medicaid
CAZZZ47676ZOtherBLUE SHIELD
CAGR0068233Medicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ62306ZOtherBLUE SHIELD
CAZZZ47675ZOtherBLUE SHIELD
CA0PA153890Medicaid
CAGR0068232Medicaid
CAGR0068235Medicaid
CAGR006823BMedicaid
CAGR006823BMedicaid
CAZZZ17828ZMedicare PIN
CAZZZ00966ZMedicare PIN
CAZZZ00967ZMedicare PIN
CA970013594OtherRAILROAD MEDICARE
CAGR0068233Medicaid
CAGR0068235Medicaid
CAZZZ00967ZMedicare PIN