Provider Demographics
NPI:1467775718
Name:WILLIAMS, REBECCA JOLENE (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOLENE
Last Name:WILLIAMS
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 1:892 NEIGHBORHOOD RD LOT 12
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5315
Mailing Address - Country:US
Mailing Address - Phone:845-943-9068
Mailing Address - Fax:845-336-7180
Practice Address - Street 1:892 NEIGHBORHOOD RD LOT 12
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5315
Practice Address - Country:US
Practice Address - Phone:845-943-9068
Practice Address - Fax:845-336-7180
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282155164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse