Provider Demographics
NPI:1396058749
Name:MARTIN, REBECCA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:102 HAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-1937
Mailing Address - Country:US
Mailing Address - Phone:315-559-8948
Mailing Address - Fax:
Practice Address - Street 1:102 HAMDEN DRIVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208
Practice Address - Country:US
Practice Address - Phone:315-559-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248666164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse