Provider Demographics
NPI:1215994645
Name:LOVERSO, REBECCA LYNNE (RPA C)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNNE
Last Name:LOVERSO
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNNE
Other - Last Name:LOVERSO-TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 DUBOIS ST
Mailing Address - Street 2:ST LUKES CORNWALL HOSPITAL - ED
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4851
Mailing Address - Country:US
Mailing Address - Phone:845-568-2305
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:ST LUKES CORNWALL HOSPITAL - ED
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:845-568-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5591363A00000X
NY012173-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078384Medicare ID - Type Unspecified
Q14079Medicare UPIN