Provider Demographics
NPI:1669817193
Name:SWEET, REBECCA L
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MIDDLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-0107
Mailing Address - Country:US
Mailing Address - Phone:315-866-7932
Mailing Address - Fax:
Practice Address - Street 1:107 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-0107
Practice Address - Country:US
Practice Address - Phone:315-866-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301884-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse