Provider Demographics
NPI:1649608506
Name:LAWRENCE, REBECCA (APN, WHNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:APN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 W 95TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2362
Mailing Address - Country:US
Mailing Address - Phone:708-857-7230
Mailing Address - Fax:708-425-5779
Practice Address - Street 1:5851 W 95TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2362
Practice Address - Country:US
Practice Address - Phone:708-857-7230
Practice Address - Fax:708-425-5779
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010819363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010819OtherILLINOIS LICENSE