Provider Demographics
NPI:1568489250
Name:MERTEN, REBECCA L (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MERTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:IL
Mailing Address - Zip Code:62411-1408
Mailing Address - Country:US
Mailing Address - Phone:618-483-6151
Mailing Address - Fax:618-483-6153
Practice Address - Street 1:8 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1408
Practice Address - Country:US
Practice Address - Phone:618-483-6151
Practice Address - Fax:618-483-6153
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004311363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP61551Medicare UPIN