Provider Demographics
NPI:1508177643
Name:DRISCOLL, REBEKAH JEAN (RN)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JEAN
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:JEAN
Other - Last Name:CHRYSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:60 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2795
Mailing Address - Country:US
Mailing Address - Phone:607-756-3401
Mailing Address - Fax:607-756-3483
Practice Address - Street 1:60 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2795
Practice Address - Country:US
Practice Address - Phone:607-756-3401
Practice Address - Fax:607-756-3483
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY545636163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health