Provider Demographics
NPI:1912249681
Name:CLAY, REBECCA JANE (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:CLAY
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 1:318 GRACE LN
Mailing Address - Street 2:PO BOX 561
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-0569
Mailing Address - Country:US
Mailing Address - Phone:937-780-7106
Mailing Address - Fax:
Practice Address - Street 1:318 GRACE LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-0569
Practice Address - Country:US
Practice Address - Phone:937-780-7106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.102414164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse