Provider Demographics
NPI:1407553092
Name:SCHMIDT, REBECCA LYN (RN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-6556
Mailing Address - Country:US
Mailing Address - Phone:217-737-7792
Mailing Address - Fax:
Practice Address - Street 1:29603 CENTER RD
Practice Address - Street 2:
Practice Address - City:ARMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61721-9454
Practice Address - Country:US
Practice Address - Phone:309-883-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.236837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse