Healthcare Provider Details

I. General information

NPI: 1427119668
Provider Name (Legal Business Name): REBECCA ANN ALTHOFF RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MONTGOMERY DR
SANTA ROSA CA
95405-4801
US

IV. Provider business mailing address

3191 MONTECITO MEADOW DR
SANTA ROSA CA
95404-1841
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-3210
  • Fax:
Mailing address:
  • Phone: 707-526-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number245526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: