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General NPI Number Information
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NPI Number | 1871073882
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Entity Type | Individual
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Provider Name | REBECCA ELIZABETH WAHL NP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2018
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 134 HOMER AVE
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City | CORTLAND
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State | NY
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Zip | 13045-1206
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Country | US
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Telephone | 607-756-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 730 STATE ROUTE 38
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City | LOCKE
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State | NY
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Zip | 13092-4132
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Country | US
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Telephone | 315-440-6376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 559339
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 308976
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License Number State | NY
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