Provider Demographics
NPI:1689940801
Name:BERKEMEIER, REBECCA K (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:BERKEMEIER
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 1:15 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:NY
Mailing Address - Zip Code:14591-9003
Mailing Address - Country:US
Mailing Address - Phone:585-991-8628
Mailing Address - Fax:
Practice Address - Street 1:15 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:NY
Practice Address - Zip Code:14591
Practice Address - Country:US
Practice Address - Phone:585-991-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305292164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse