Provider Demographics
NPI:1700832326
Name:VEASEY, REBECCA ELLEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELLEN
Last Name:VEASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ELLEN
Other - Last Name:BEVERSDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:SUITE 100 (ATTN: MELVONNE JONES)
Mailing Address - City:BOLINGBROCK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-0000
Mailing Address - Country:US
Mailing Address - Phone:630-914-2417
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:856 NORTH CONVENT
Practice Address - Street 2:SUITE C
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-0000
Practice Address - Country:US
Practice Address - Phone:815-936-5167
Practice Address - Fax:630-914-2469
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001046363A00000X
IL085.001046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085001046Medicaid
4622394OtherBCBS
S24189Medicare UPIN
L84477Medicare PIN
4622394OtherBCBS
IL085001046Medicaid