Provider Demographics
NPI:1326745142
Name:LEESE, REBECCA JAYNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JAYNE
Last Name:LEESE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4738
Mailing Address - Country:US
Mailing Address - Phone:570-220-2301
Mailing Address - Fax:
Practice Address - Street 1:890 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-4738
Practice Address - Country:US
Practice Address - Phone:570-220-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN335698L163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant