Provider Demographics
NPI:1417666280
Name:REPKORWICH, RACHEL LEE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEE
Last Name:REPKORWICH
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 1:10 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-1511
Mailing Address - Country:US
Mailing Address - Phone:203-654-5503
Mailing Address - Fax:
Practice Address - Street 1:10 MEADOW LN
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1511
Practice Address - Country:US
Practice Address - Phone:203-654-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310946363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health