Provider Demographics
NPI:1306899182
Name:TODD, REBECCA A (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:TODD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NE GLEN OAK AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603
Mailing Address - Country:US
Mailing Address - Phone:309-674-2002
Mailing Address - Fax:309-674-0774
Practice Address - Street 1:515 NE GLEN OAK AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603
Practice Address - Country:US
Practice Address - Phone:309-674-2002
Practice Address - Fax:309-674-0774
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0041296072363LF0000X
IL041-296072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL500003427OtherRAILROAD MEDICARE
IL07215075OtherBCBS OF ILLINOIS
ILIL0101OtherJOHN DEERE HEALTH
IL500003427OtherRAILROAD MEDICARE
ILIL0101OtherJOHN DEERE HEALTH