Healthcare Provider Details

I. General information

NPI: 1710464136
Provider Name (Legal Business Name): REBEKAH ANN SALLES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HILAND AVE STE F
BURLEY ID
83318-2682
US

IV. Provider business mailing address

55 PLAZA CIR STE A
SALINAS CA
93901-2952
US

V. Phone/Fax

Practice location:
  • Phone: 208-677-6212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number72003
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: