Provider Demographics
NPI:1255800512
Name:RODRIGUEZ, REBECCA LYNNE (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNNE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 1/2 W 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-3106
Mailing Address - Country:US
Mailing Address - Phone:315-591-4605
Mailing Address - Fax:
Practice Address - Street 1:621 1/2 W 4TH ST S
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-3106
Practice Address - Country:US
Practice Address - Phone:315-224-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse