Healthcare Provider Details

I. General information

NPI: 1033759162
Provider Name (Legal Business Name): JESSICA MARY REHO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STRATHALLAN PARK APT 5
ROCHESTER NY
14607-1534
US

IV. Provider business mailing address

25 STRATHALLAN PARK APT 5
ROCHESTER NY
14607-1534
US

V. Phone/Fax

Practice location:
  • Phone: 585-613-5475
  • Fax:
Mailing address:
  • Phone: 585-613-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number682119-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: