Provider Demographics
NPI:1104017557
Name:RUBIN, LILLYE B
Entity Type:Individual
Prefix:MS
First Name:LILLYE
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:301 GUSTAVA STREET
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-0266
Mailing Address - Country:US
Mailing Address - Phone:318-728-7226
Mailing Address - Fax:318-728-0577
Practice Address - Street 1:301 GUSTAVA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3659
Practice Address - Country:US
Practice Address - Phone:318-728-7226
Practice Address - Fax:318-728-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion