Provider Demographics
NPI:1417602095
Name:CERVANIA, RACHEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:RACHEN
Middle Name:
Last Name:CERVANIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 COFFEE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3122
Mailing Address - Country:US
Mailing Address - Phone:209-248-7168
Mailing Address - Fax:
Practice Address - Street 1:1552 COFFEE RD STE 200
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3122
Practice Address - Country:US
Practice Address - Phone:209-248-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2022-07-26
Deactivation Date:2022-06-25
Deactivation Code:
Reactivation Date:2022-07-22
Provider Licenses
StateLicense IDTaxonomies
CA95018768363LF0000X
CA789806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse