Provider Demographics
NPI:1760227425
Name:LOBDELL, REBECCA SUE (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:LOBDELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 STATE HIGHWAY 310 STE 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1436
Mailing Address - Country:US
Mailing Address - Phone:315-386-2189
Mailing Address - Fax:315-386-2435
Practice Address - Street 1:80 STATE HIGHWAY 310 STE 1
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1436
Practice Address - Country:US
Practice Address - Phone:315-386-2189
Practice Address - Fax:315-386-2435
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY893206163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)