Provider Demographics
NPI:1710347893
Name:VILLARREAL, RACHAEL WHITNEY (APN)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:WHITNEY
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:WHITNEY
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1475 KISKER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8781
Mailing Address - Country:US
Mailing Address - Phone:366-498-7406
Mailing Address - Fax:
Practice Address - Street 1:6505 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:314-687-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014435363L00000X
IL209.014435363LF0000X
MO2016005846363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily