Provider Demographics
NPI:1912044397
Name:COLL SCHOOLEY, REBECCA (LPN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:COLL SCHOOLEY
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-0086
Mailing Address - Country:US
Mailing Address - Phone:440-867-8626
Mailing Address - Fax:440-867-2461
Practice Address - Street 1:167 WOOD ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-867-8626
Practice Address - Fax:440-867-2461
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN076565164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2689667Medicaid