Provider Demographics
NPI:1356689525
Name:HAMPTON, REBECCA IRENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:IRENE
Last Name:HAMPTON
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:P.O. BOX 483
Mailing Address - Street 2:1741 MILL STREET
Mailing Address - City:DERUYTER
Mailing Address - State:NY
Mailing Address - Zip Code:13052
Mailing Address - Country:US
Mailing Address - Phone:315-852-2100
Mailing Address - Fax:
Practice Address - Street 1:1741 MILL ST
Practice Address - Street 2:
Practice Address - City:DERUYTER
Practice Address - State:NY
Practice Address - Zip Code:13052
Practice Address - Country:US
Practice Address - Phone:315-852-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290194-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse