Provider Demographics
NPI:1831388495
Name:RECTOR, MILISSA ANNE (LPN)
Entity type:Individual
Prefix:MS
First Name:MILISSA
Middle Name:ANNE
Last Name:RECTOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MILISSA
Other - Middle Name:ANNE
Other - Last Name:VANVALKENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:520 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1770
Mailing Address - Country:US
Mailing Address - Phone:585-409-9485
Mailing Address - Fax:
Practice Address - Street 1:520 NORTH STREET
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1770
Practice Address - Country:US
Practice Address - Phone:585-409-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219724164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01895165Medicaid