Provider Demographics
NPI:1477077543
Name:VIERRA-BRICK, REBECCA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:VIERRA-BRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:VIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:MI WUK VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:95346-0513
Mailing Address - Country:US
Mailing Address - Phone:209-694-9054
Mailing Address - Fax:
Practice Address - Street 1:18880 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9506
Practice Address - Country:US
Practice Address - Phone:209-928-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty