Basic Information
| Provider Information | |||||||||
| NPI: | 1023180007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENSCHLER | ||||||||
| FirstName: | NICHOLE | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MACHO | ||||||||
| OtherFirstName: | NICHOLE | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PAC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 255228 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958655228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8857710335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8170 LAGUNA BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957587902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168877940 | ||||||||
| FaxNumber: | 9168874045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | PA15389 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 363A00000X | 15389 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970013594 | 01 | CA | RAILROAD MEDICARE | OTHER | GR0068230 | 05 | CA | MEDICAID | GR0068231 | 05 | CA | MEDICAID | ZZZ47676Z | 01 | CA | BLUE SHIELD | OTHER | GR0068233 | 05 | CA | MEDICAID | ZZZ47673Z | 01 | CA | BLUE SHIELD | OTHER | ZZZ62306Z | 01 | CA | BLUE SHIELD | OTHER | ZZZ47675Z | 01 | CA | BLUE SHIELD | OTHER | 0PA153890 | 05 | CA | MEDICAID | GR0068232 | 05 | CA | MEDICAID | GR0068235 | 05 | CA | MEDICAID | GR006823B | 05 | CA | MEDICAID |