Individual
KRISTEN J REWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
632 W GIBSON RD, WOODLAND, CA 95695-5169
(530) 668-2600
(530) 668-6463
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000210235
TN
363L00000X
Nurse Practitioner
95005492
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
95005492
CA
Other
Enumeration date
08/29/2016
Last updated
10/23/2020
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