Provider Demographics
NPI:1801085170
Name:WROBLEWSKI, REBECCA L
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WROBLEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8346 DATUM LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-6201
Mailing Address - Country:US
Mailing Address - Phone:315-715-4199
Mailing Address - Fax:
Practice Address - Street 1:8346 DATUM LN
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-6201
Practice Address - Country:US
Practice Address - Phone:315-715-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287146164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse