Provider Demographics
NPI:1669504999
Name:DEAN, REBECCA M (CNS)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 RIO BONITO DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5215
Mailing Address - Country:US
Mailing Address - Phone:916-716-2874
Mailing Address - Fax:
Practice Address - Street 1:6320 RIO BONITO DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-5215
Practice Address - Country:US
Practice Address - Phone:916-716-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397499364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05376ZMedicare PIN