MEDICARE: MRS. NICHOLE MICHELLE RENSCHLER PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	PA15389	CA
2	363A00000X	Physician Assistant	15389	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970013594	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ZZZ47676Z	OTHER	CA	BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	ZZZ47673Z	OTHER	CA	BLUE SHIELD
7	ZZZ62306Z	OTHER	CA	BLUE SHIELD
8	ZZZ47675Z	OTHER	CA	BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023180007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLE MICHELLE RENSCHLER PAC

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:	885-771-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	8170 LAGUNA BLVD STE 114
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7902
Country	:	US
Telephone Number	:	916-887-7940
Fax Number	:	916-887-4045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/21/2022

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Directions to “ MRS. NICHOLE MICHELLE RENSCHLER PAC” Practice Location

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