Healthcare Provider Details

I. General information

NPI: 1952841744
Provider Name (Legal Business Name): REBECCA M VOLAND LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3976 E 54TH ST
NEWBURGH HEIGHTS OH
44105-4851
US

IV. Provider business mailing address

3976 E 54TH ST
NEWBURGH HEIGHTS OH
44105-4851
US

V. Phone/Fax

Practice location:
  • Phone: 216-952-7099
  • Fax:
Mailing address:
  • Phone: 216-952-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 121576 MEDS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: