Provider Demographics
NPI:1952664534
Name:WENIG, REBECCA (CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WENIG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5646
Mailing Address - Country:US
Mailing Address - Phone:312-666-3494
Mailing Address - Fax:312-432-4372
Practice Address - Street 1:1701 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5646
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:312-432-4372
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009199367A00000X
IL209.009199367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife