Provider Demographics
NPI:1972693836
Name:LEDWIN, REBECCA KATHLEEN (MS, RN, PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:KATHLEEN
Last Name:LEDWIN
Suffix:
Gender:F
Credentials:MS, RN, PNP-BC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:KATHLEEN
Other - Last Name:LEDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP-BC
Mailing Address - Street 1:16 BORDEAUX WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-4614
Mailing Address - Country:US
Mailing Address - Phone:585-683-1413
Mailing Address - Fax:
Practice Address - Street 1:22 RED JACKET ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9502
Practice Address - Country:US
Practice Address - Phone:585-335-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380349-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02074826Medicaid