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General NPI Number Information
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NPI Number | 1205018744
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Entity Type | Individual
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Provider Name | REBECCA LYNNE MACISAAC NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 7000 EAST AVE
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City | LIVERMORE
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State | CA
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Zip | 94550-9698
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Country | US
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Telephone | 925-422-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 7011 EAST AVE, BUILDING 925 MS9112
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City | LIVERMORE
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State | CA
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Zip | 94550
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Country | US
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Telephone | 925-294-6032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95004504
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License Number State | CA
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