Provider Demographics
NPI:1568751733
Name:RICHARDSON, REBEKAH S (LPN)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:S
Last Name:RICHARDSON
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 1:819 EASTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1429
Mailing Address - Country:US
Mailing Address - Phone:516-338-7554
Mailing Address - Fax:
Practice Address - Street 1:819 EASTFIELD RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1429
Practice Address - Country:US
Practice Address - Phone:516-338-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse