1972693836 NPI number — MS. REBECCA KATHLEEN LEDWIN MS, RN, PNP-BC

Table of content: MS. REBECCA KATHLEEN LEDWIN MS, RN, PNP-BC (NPI 1972693836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972693836 NPI number — MS. REBECCA KATHLEEN LEDWIN MS, RN, PNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDWIN
Provider First Name:
REBECCA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RN, PNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEDWIN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972693836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 BORDEAUX WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14450-4614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-683-1413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 RED JACKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14437-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-335-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  F380349-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02074826 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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