Provider Demographics
NPI:1689305070
Name:MENA, REBECCA MARISSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARISSA
Last Name:MENA
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 1:1016 HICKS ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-4349
Mailing Address - Country:US
Mailing Address - Phone:559-356-9362
Mailing Address - Fax:
Practice Address - Street 1:2021 HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6316
Practice Address - Country:US
Practice Address - Phone:559-797-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily