Healthcare Provider Details

I. General information

NPI: 1770818700
Provider Name (Legal Business Name): REBECCA ELLA VROOMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 COUNTY ROUTE 41
MEXICO NY
13114
US

IV. Provider business mailing address

503 COUNTY ROUTE 41
MEXICO NY
13114
US

V. Phone/Fax

Practice location:
  • Phone: 315-529-3887
  • Fax:
Mailing address:
  • Phone: 315-529-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number476532-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: