Provider Demographics
NPI:1538289541
Name:CAVE, REBECCA LYNN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LYNN
Last Name:CAVE
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 1:7722 BASSETT DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2107
Mailing Address - Country:US
Mailing Address - Phone:937-260-4420
Mailing Address - Fax:
Practice Address - Street 1:7722 BASSETT DR
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2107
Practice Address - Country:US
Practice Address - Phone:937-260-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN104822164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2398025Medicaid