Provider Demographics
NPI:1780638072
Name:WEST, REBECCA R (ARNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:WEST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:635 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-2963
Practice Address - Country:US
Practice Address - Phone:815-772-7491
Practice Address - Fax:815-772-7891
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0732651Medicaid
19357OtherMIDLANDS CHOICE
27171OtherIOWA HEALTH SOLUTIONS
018410OtherHEALTH ALLIANCE
IL0142OtherJOHN DEERE HEALTH
27171OtherIOWA HEALTH SOLUTIONS`
ILK46128Medicare PIN
IA0732651Medicaid
500029380Medicare PIN
R84249Medicare UPIN
19357OtherMIDLANDS CHOICE