Healthcare Provider Details

I. General information

NPI: 1235572926
Provider Name (Legal Business Name): REBECCA MAUDE HURD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 PINE ST
WELLSVILLE NY
14895-1421
US

IV. Provider business mailing address

102 N MAIN ST
WELLSVILLE NY
14895-1250
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-6052
  • Fax:
Mailing address:
  • Phone: 585-593-3760
  • Fax: 585-593-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number285591-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: