Basic Information
| Provider Information | |||||||||
| NPI: | 1780638072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 13TH AVE N | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527325067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632432511 | ||||||||
| FaxNumber: | 5632430817 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 E LINCOLNWAY | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612702963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157727491 | ||||||||
| FaxNumber: | 8157727891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209000539 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0732651 | 05 | IA | MEDICAID | 19357 | 01 | MIDLANDS CHOICE | OTHER | 27171 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 018410 | 01 | HEALTH ALLIANCE | OTHER | IL0142 | 01 | JOHN DEERE HEALTH | OTHER |