Provider Demographics
NPI:1568771749
Name:FOTH, REBECCA ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:FOTH
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 1:11 FIRST ST.
Mailing Address - Street 2:PO BOX 313
Mailing Address - City:ANDOVER
Mailing Address - State:NY
Mailing Address - Zip Code:14806
Mailing Address - Country:US
Mailing Address - Phone:607-478-5212
Mailing Address - Fax:
Practice Address - Street 1:83 PINE ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1421
Practice Address - Country:US
Practice Address - Phone:585-593-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281945-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse