Provider Demographics
NPI:1154968972
Name:COWLEY, REBECCA LEE (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:COWLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEE
Other - Last Name:KEHOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:245 MAIN ST APT D
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1762
Mailing Address - Country:US
Mailing Address - Phone:631-334-8741
Mailing Address - Fax:
Practice Address - Street 1:245 MAIN ST APT D
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1762
Practice Address - Country:US
Practice Address - Phone:631-334-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336070164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA