Provider Demographics
NPI:1164198925
Name:RATCLIFF, ROBERT A (FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 KIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6505
Mailing Address - Country:US
Mailing Address - Phone:630-484-7055
Mailing Address - Fax:
Practice Address - Street 1:308 KIMBERLY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6505
Practice Address - Country:US
Practice Address - Phone:630-484-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine