Provider Demographics
NPI:1215247655
Name:VERBANIC, REBECCA ELEANOR (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELEANOR
Last Name:VERBANIC
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 1:8988 PAWLING RD
Mailing Address - Street 2:
Mailing Address - City:COHOCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14826-9771
Mailing Address - Country:US
Mailing Address - Phone:607-331-9989
Mailing Address - Fax:
Practice Address - Street 1:8988 PAWLING RD
Practice Address - Street 2:
Practice Address - City:COHOCTON
Practice Address - State:NY
Practice Address - Zip Code:14826-9771
Practice Address - Country:US
Practice Address - Phone:607-331-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3020901164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse