Provider Demographics
NPI:1770874968
Name:COLEMAN, REBECCA RUTH (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:COLEMAN
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 1:7291 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:NY
Mailing Address - Zip Code:14485-9722
Mailing Address - Country:US
Mailing Address - Phone:585-624-4161
Mailing Address - Fax:
Practice Address - Street 1:7291 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:NY
Practice Address - Zip Code:14485-9722
Practice Address - Country:US
Practice Address - Phone:585-624-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451858-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse