Basic Information
| Provider Information | |||||||||
| NPI: | 1689925190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGEE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LEILANI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BUTLER | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | LEILANI | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 455 PINELLAS STREET | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451911 | ||||||||
| FaxNumber: | 7274451986 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 PINELLAS STREET | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451911 | ||||||||
| FaxNumber: | 7274451911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2012 | ||||||||
| LastUpdateDate: | 09/24/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN1192021 | FL | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.