Provider Demographics
NPI:1861653800
Name:WILLENBORG, REBECCA ANN (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:WILLENBORG
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3087
Practice Address - Country:US
Practice Address - Phone:916-733-7977
Practice Address - Fax:916-733-7979
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF11414363LF0000X
CANP11414363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily