=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295068112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBECCA L BOOKLESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2009
-----------------------------------------------------
Last Update Date | 09/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 TIMBER RUN RD
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-9108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-683-2904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 TIMBER RUN RD
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-9108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-683-2904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPN
-----------------------------------------------------
Name | MS. REBECCA L BOOKLESS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-683-2904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | PN084391
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------