Provider Demographics
NPI:1407444664
Name:FEASEL, REBECCA RUTH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:FEASEL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5157 EL SECRITO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6452
Mailing Address - Country:US
Mailing Address - Phone:928-581-4854
Mailing Address - Fax:
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3733
Practice Address - Country:US
Practice Address - Phone:760-533-7953
Practice Address - Fax:619-269-2676
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95137241163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty