Provider Demographics
NPI:1669641395
Name:RUPERT, REBECCA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:RUPERT
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 1:6965 COUNTY HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:BERGHOLZ
Mailing Address - State:OH
Mailing Address - Zip Code:43908-7947
Mailing Address - Country:US
Mailing Address - Phone:740-768-2716
Mailing Address - Fax:740-768-2719
Practice Address - Street 1:6965 COUNTY HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:BERGHOLZ
Practice Address - State:OH
Practice Address - Zip Code:43908-7947
Practice Address - Country:US
Practice Address - Phone:740-768-2716
Practice Address - Fax:740-768-2719
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN098447IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2225854Medicaid