Provider Demographics
NPI:1295864619
Name:NORWICK, REBECCA (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NORWICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MENDOCINO AVENUE
Mailing Address - Street 2:STUDENT HEALTH SERVICES SRJC
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4395
Mailing Address - Country:US
Mailing Address - Phone:707-547-2222
Mailing Address - Fax:707-547-2229
Practice Address - Street 1:1501 MENDOCINO AVENUE
Practice Address - Street 2:SANTA ROSA JUNIOR COLLEGE
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4395
Practice Address - Country:US
Practice Address - Phone:707-527-4445
Practice Address - Fax:707-547-2229
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-10-07
Deactivation Date:2022-05-19
Deactivation Code:
Reactivation Date:2022-08-09
Provider Licenses
StateLicense IDTaxonomies
CAFNP 15435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner