Provider Demographics
NPI:1821489154
Name:JEWELL, MARCIA (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:REBMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1364
Mailing Address - Country:US
Mailing Address - Phone:585-396-3821
Mailing Address - Fax:585-396-3957
Practice Address - Street 1:435 EAST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1364
Practice Address - Country:US
Practice Address - Phone:585-396-3821
Practice Address - Fax:585-396-3957
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487261163WS0200X
NY487261-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY487261OtherNY STATE NURSING LICENSE