Provider Demographics
NPI:1518361682
Name:ECK, ROSEMARIE RENEE (APN)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:RENEE
Last Name:ECK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 N VERMILION ST
Mailing Address - Street 2:B-389
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1700
Mailing Address - Country:US
Mailing Address - Phone:773-755-2510
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST, BLDG 101-171
Practice Address - Street 2:VA ILLIANA HEALTH CARE SYSTEM
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:773-755-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6072-33363LA2200X, 363LG0600X
IL209.012158363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care