Provider Demographics
NPI:1669085460
Name:MCKINLEY, REBECCA LEE (STNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 US HIGHWAY 20 LOT 136
Mailing Address - Street 2:
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-8985
Mailing Address - Country:US
Mailing Address - Phone:419-577-9178
Mailing Address - Fax:
Practice Address - Street 1:5810 US HIGHWAY 20 LOT 136
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889-8985
Practice Address - Country:US
Practice Address - Phone:419-577-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400898930409374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide