Provider Demographics
NPI:1659875748
Name:WAY, REBECCA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:WAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEE
Other - Last Name:PLUNKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:STITTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13469-0076
Mailing Address - Country:US
Mailing Address - Phone:315-335-6539
Mailing Address - Fax:
Practice Address - Street 1:7488 STATE ROUTE 291
Practice Address - Street 2:
Practice Address - City:STITTVILLE
Practice Address - State:NY
Practice Address - Zip Code:13469
Practice Address - Country:US
Practice Address - Phone:315-335-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274268164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse