Provider Demographics
NPI:1356719736
Name:DELONG, RACHEL (APN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DELONG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:HUTSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1001 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1907
Mailing Address - Country:US
Mailing Address - Phone:309-495-0201
Mailing Address - Fax:309-676-6545
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1907
Practice Address - Country:US
Practice Address - Phone:309-495-0201
Practice Address - Fax:309-676-6545
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400254621Medicare PIN