Provider Demographics
NPI:1720543267
Name:DAVIS-TELLEZ, REBECA (RN)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:DAVIS-TELLEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WEANTINOCK DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3084
Mailing Address - Country:US
Mailing Address - Phone:305-720-9836
Mailing Address - Fax:
Practice Address - Street 1:29 WEANTINOCK DR
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3084
Practice Address - Country:US
Practice Address - Phone:305-720-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70486-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health