Provider Demographics
NPI:1588068464
Name:MERCHIORI, REBECCA J (APN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:MERCHIORI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:HARRISTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2408
Mailing Address - Country:US
Mailing Address - Phone:314-776-7999
Mailing Address - Fax:314-772-2257
Practice Address - Street 1:1120 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-6927
Practice Address - Country:US
Practice Address - Phone:618-395-5222
Practice Address - Fax:618-395-8552
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012066363LA2200X
IL309.007726363LG0600X, 363LP0808X
MO2017035715363LG0600X
MO2021003533363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology