Provider Demographics
NPI:1740292739
Name:DAY, REBECCA J (PA - FNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:DAY
Suffix:
Gender:F
Credentials:PA - FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2224
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-5224
Mailing Address - Country:US
Mailing Address - Phone:209-499-4852
Mailing Address - Fax:
Practice Address - Street 1:1425 W H ST
Practice Address - Street 2:380
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3588
Practice Address - Country:US
Practice Address - Phone:209-847-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13692363AM0700X
CA350628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13692Medicaid
CAPA13692Medicaid
CAS73084Medicare UPIN