Healthcare Provider Details

I. General information

NPI: 1932867603
Provider Name (Legal Business Name): VICTORIA REBMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 MEADOW DR
NORTH TONAWANDA NY
14120-2815
US

IV. Provider business mailing address

237 WHEATFIELD ST
NORTH TONAWANDA NY
14120-6939
US

V. Phone/Fax

Practice location:
  • Phone: 716-694-2001
  • Fax:
Mailing address:
  • Phone: 716-474-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number820574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: