Provider Demographics
NPI:1477636058
Name:BOEHME, REBECCA S (RN FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:BOEHME
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:THIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN FNP
Mailing Address - Street 1:725 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2133
Mailing Address - Country:US
Mailing Address - Phone:530-926-4556
Mailing Address - Fax:530-926-4532
Practice Address - Street 1:725 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2133
Practice Address - Country:US
Practice Address - Phone:530-926-4556
Practice Address - Fax:530-926-4532
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP3799363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care