Provider Demographics
NPI:1023258803
Name:LAWALL, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LAWALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 E MAIN ST
Mailing Address - Street 2:#2F
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2833
Mailing Address - Country:US
Mailing Address - Phone:585-329-7242
Mailing Address - Fax:
Practice Address - Street 1:679 E MAIN ST
Practice Address - Street 2:#2F
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2833
Practice Address - Country:US
Practice Address - Phone:585-329-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490622-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse