Provider Demographics
NPI:1790775849
Name:GILPIN, REBEKAH SUZANNE (RN FAMILY NURSE PRAC)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:SUZANNE
Last Name:GILPIN
Suffix:
Gender:F
Credentials:RN FAMILY NURSE PRAC
Other - Prefix:
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Mailing Address - Street 1:2802 TIBER AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2959
Mailing Address - Country:US
Mailing Address - Phone:530-753-6947
Mailing Address - Fax:
Practice Address - Street 1:1641 CREEKSIDE DR
Practice Address - Street 2:#201
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3831
Practice Address - Country:US
Practice Address - Phone:916-984-4100
Practice Address - Fax:916-984-4154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA6788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ43400ZMedicare ID - Type Unspecified