MEDICARE: REBECCA BOISCLAIR RN

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	163WC0200X	Critical Care Medicine Registered Nurse	95198765	CA

General Provider Information

NPI Number	:	1831033646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BOISCLAIR RN

Provider Business Mailing Address
First Line	:	3131 TWO RIVERS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-9604
Country	:	US
Telephone Number	:	818-935-1778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 TWO RIVERS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-9604
Country	:	US
Telephone Number	:	818-935-1778
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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