Provider Demographics
NPI:1336308980
Name:GOTHAM, REBECCA MAUREEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MAUREEN
Last Name:GOTHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 PLAZA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4413
Mailing Address - Country:US
Mailing Address - Phone:916-771-9555
Mailing Address - Fax:916-771-9556
Practice Address - Street 1:2204 PLAZA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4413
Practice Address - Country:US
Practice Address - Phone:916-771-9555
Practice Address - Fax:916-771-9556
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse