Provider Demographics
NPI:1992728851
Name:RACCONE, NANCY LEA (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LEA
Last Name:RACCONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6866
Mailing Address - Country:US
Mailing Address - Phone:309-762-9800
Mailing Address - Fax:309-764-3871
Practice Address - Street 1:4300 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6866
Practice Address - Country:US
Practice Address - Phone:309-762-9800
Practice Address - Fax:309-764-3871
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361144451Medicaid
IL93191OtherBCBS
ILE41438Medicare UPIN
ILK23050Medicare ID - Type Unspecified