Provider Demographics
NPI:1609414119
Name:RECOB, LAURA ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:RECOB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 WYNMERE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BELOIT
Mailing Address - State:IL
Mailing Address - Zip Code:61080-9214
Mailing Address - Country:US
Mailing Address - Phone:630-951-9511
Mailing Address - Fax:
Practice Address - Street 1:7180 SPRING BROOK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6700
Practice Address - Country:US
Practice Address - Phone:815-971-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily