1942258744 NPI number — MRS. REBECCA E BRIGGS FNP

Table of content: MRS. REBECCA E BRIGGS FNP (NPI 1942258744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942258744 NPI number — MRS. REBECCA E BRIGGS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIGGS
Provider First Name:
REBECCA
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942258744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6386 GREELEY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COULTERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-878-0155
Provider Business Mailing Address Fax Number:
209-878-0145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6386 GREELEY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COULTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95311-9572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-689-4111
Provider Business Practice Location Address Fax Number:
916-689-6620
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  14537 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 14537 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01114968 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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