Provider Demographics
NPI:1245007079
Name:AXE, REBECCA DANIELLE (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DANIELLE
Last Name:AXE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 PLEASANTVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43148-9513
Mailing Address - Country:US
Mailing Address - Phone:740-215-0295
Mailing Address - Fax:
Practice Address - Street 1:4014 VENTURE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9600
Practice Address - Country:US
Practice Address - Phone:866-579-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.388233163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice