Provider Demographics
NPI:1154038925
Name:MATSIKO, REBECCA N (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:MATSIKO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2531
Mailing Address - Country:US
Mailing Address - Phone:781-856-1486
Mailing Address - Fax:
Practice Address - Street 1:36 HUDSON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2531
Practice Address - Country:US
Practice Address - Phone:781-856-1486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN600002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse