Healthcare Provider Details

I. General information

NPI: 1760703136
Provider Name (Legal Business Name): DENISE MARIE REPPENHAGEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 AVENIDA ENCINAS STE 100
CARLSBAD CA
92008-4375
US

IV. Provider business mailing address

1955 CITRACADO PKWY STE 203
ESCONDIDO CA
92029-4112
US

V. Phone/Fax

Practice location:
  • Phone: 760-448-4412
  • Fax:
Mailing address:
  • Phone: 760-448-4412
  • Fax: 760-918-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: