Provider Demographics
NPI:1194967570
Name:JASCH, REBECCA (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JASCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SUNSET AVE.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-7000
Mailing Address - Country:US
Mailing Address - Phone:207-778-6841
Mailing Address - Fax:
Practice Address - Street 1:125 SUNSET AVE.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-7000
Practice Address - Country:US
Practice Address - Phone:207-778-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER022974163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse