Provider Demographics
NPI:1760039267
Name:FELDMANN, REBECCA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:FELDMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:MIXER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:18 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-1313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 PLAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1993
Practice Address - Country:US
Practice Address - Phone:508-733-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN95550164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse