Healthcare Provider Details

I. General information

NPI: 1073949012
Provider Name (Legal Business Name): REBECCA HOEWELER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE BOX 0210
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

3141 COLLEGE AVE APT 2
BERKELEY CA
94705-2754
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-8930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: