Provider Demographics
NPI:1265814180
Name:DAMAZO, REBEKAH (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:DAMAZO
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:THORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6888 DEAN PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-2375
Mailing Address - Country:US
Mailing Address - Phone:530-591-5812
Mailing Address - Fax:
Practice Address - Street 1:6888 DEAN PL
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-2375
Practice Address - Country:US
Practice Address - Phone:530-591-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246775163W00000X
CA2667363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse