Provider Demographics
NPI:1104105295
Name:CAESAR, REBECCA JEAN
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:CAESAR
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 1:5 1/2 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5505
Mailing Address - Country:US
Mailing Address - Phone:607-341-6311
Mailing Address - Fax:
Practice Address - Street 1:5 1/2 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5505
Practice Address - Country:US
Practice Address - Phone:607-341-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304329-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse