Provider Demographics
NPI:1750781993
Name:WOODBURY, RHONDA L (NP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:L
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 7630
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7002
Mailing Address - Country:US
Mailing Address - Phone:847-244-6320
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST STE 500A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-2038
Practice Address - Country:US
Practice Address - Phone:309-672-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily