Provider Demographics
NPI:1003917717
Name:SAUNDERS, REBECCA L (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19665
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9665
Mailing Address - Country:US
Mailing Address - Phone:217-545-7500
Mailing Address - Fax:217-545-7305
Practice Address - Street 1:301 N 8TH ST
Practice Address - Street 2:PAV 4B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1041
Practice Address - Country:US
Practice Address - Phone:217-545-7500
Practice Address - Fax:217-545-7305
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006151363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL522000Medicare PIN
IL$$$$$$$$$001Medicaid
Q72684Medicare UPIN