Provider Demographics
NPI:1861013856
Name:TRAXLER, REBECCA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:TRAXLER
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 1:360 SPRINGBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8964
Mailing Address - Country:US
Mailing Address - Phone:440-452-3009
Mailing Address - Fax:
Practice Address - Street 1:360 SPRINGBROOK CIR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-8964
Practice Address - Country:US
Practice Address - Phone:440-452-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN087634164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PN087634OtherINDEPENDENT