Provider Demographics
NPI:1952476103
Name:BARRICK, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:STUDEBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5401 N KNOXVILLE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5095
Mailing Address - Country:US
Mailing Address - Phone:309-691-2903
Mailing Address - Fax:309-691-2909
Practice Address - Street 1:5401 N KNOXVILLE AVE STE 115
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5068
Practice Address - Country:US
Practice Address - Phone:309-691-2903
Practice Address - Fax:309-691-2909
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002089363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical