Healthcare Provider Details

I. General information

NPI: 1831033646
Provider Name (Legal Business Name): REBECCA BOISCLAIR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 TWO RIVERS DR
SACRAMENTO CA
95833-9604
US

IV. Provider business mailing address

3131 TWO RIVERS DR
SACRAMENTO CA
95833-9604
US

V. Phone/Fax

Practice location:
  • Phone: 818-935-1778
  • Fax:
Mailing address:
  • Phone: 818-935-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95198765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: