Provider Demographics
NPI:1942989652
Name:AGNELLO, REBEKKA E
Entity Type:Individual
Prefix:
First Name:REBEKKA
Middle Name:E
Last Name:AGNELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PINE ST APT 319
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5879
Mailing Address - Country:US
Mailing Address - Phone:860-822-3507
Mailing Address - Fax:
Practice Address - Street 1:185 PINE ST APT 319
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5879
Practice Address - Country:US
Practice Address - Phone:860-822-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program