Provider Demographics
NPI:1134193360
Name:LEDBETTER, RITA JOAN (CNM)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:JOAN
Last Name:LEDBETTER
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 1:600 JOHN DEERE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6812
Mailing Address - Country:US
Mailing Address - Phone:309-779-4272
Mailing Address - Fax:
Practice Address - Street 1:600 JOHN DEERE RD
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6869
Practice Address - Country:US
Practice Address - Phone:309-779-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0041223314367A00000X
IL209001758367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife