Provider Demographics
NPI:1992927727
Name:SLONE, REBECCA LYNN (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:SLONE
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 1:4360 TOWNLINE ROAD 12
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9666
Mailing Address - Country:US
Mailing Address - Phone:567-224-5341
Mailing Address - Fax:
Practice Address - Street 1:4360 TOWNLINE ROAD 12
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9666
Practice Address - Country:US
Practice Address - Phone:567-224-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 413494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2480239Medicaid