Provider Demographics
NPI:1275949737
Name:BOOKLESS, REBECCA (LPN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:BOOKLESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 TIMBER RUN RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9108
Mailing Address - Country:US
Mailing Address - Phone:740-683-2904
Mailing Address - Fax:
Practice Address - Street 1:380 TIMBER RUN RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-9108
Practice Address - Country:US
Practice Address - Phone:740-683-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 084391372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion