Provider Demographics
NPI:1588247456
Name:GAUS, REBECCA BROOKE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BROOKE
Last Name:GAUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ENTERPRISE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9227
Mailing Address - Country:US
Mailing Address - Phone:706-321-0476
Mailing Address - Fax:
Practice Address - Street 1:106 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9227
Practice Address - Country:US
Practice Address - Phone:706-321-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily