Provider Demographics
NPI:1275009797
Name:COMPO, REBECCA M (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:COMPO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1745
Mailing Address - Country:US
Mailing Address - Phone:315-528-7198
Mailing Address - Fax:
Practice Address - Street 1:221 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1707
Practice Address - Country:US
Practice Address - Phone:315-393-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY735984-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health