Provider Demographics
NPI:1497221725
Name:FLORES, REBECCA DELAINE (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DELAINE
Last Name:FLORES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DELAINE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:485 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2421
Mailing Address - Country:US
Mailing Address - Phone:919-464-6908
Mailing Address - Fax:
Practice Address - Street 1:675 3RD AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5731
Practice Address - Country:US
Practice Address - Phone:919-464-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY755546163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical