MEDICARE: MRS. RHONDA LEE KUBILIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN2278847	MA

General Provider Information

NPI Number	:	1851654917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA LEE KUBILIS RN

Provider Business Mailing Address
First Line	:	26 KILLDEER ISLAND RD
Second Line	:
City	:	WEBSTER
State	:	MA
Zip	:	01570-3302
Country	:	US
Telephone Number	:	508-341-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 KILLDEER ISLAND RD
Second Line	:
City	:	WEBSTER
State	:	MA
Zip	:	01570-3302
Country	:	US
Telephone Number	:	508-341-1928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	06/22/2012

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