Provider Demographics
NPI:1295263648
Name:KAUK, REBECCA MICHEL (FNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MICHEL
Last Name:KAUK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MICHEL
Other - Last Name:ISMEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:719-229-8759
Mailing Address - Fax:
Practice Address - Street 1:280 SIERRA COLLEGE DR STE 115
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-477-3119
Practice Address - Fax:530-274-2077
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95063623OtherREGISTERED NURSE