MEDICARE: REBECCA KAECHELE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-181432	AL

General Provider Information

NPI Number	:	1821669573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA KAECHELE APRN

Provider Business Mailing Address
First Line	:	200 GREEN BAY RD
Second Line	:
City	:	HIGHWOOD
State	:	IL
Zip	:	60040-1703
Country	:	US
Telephone Number	:	847-235-2139
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 GREEN BAY RD
Second Line	:
City	:	HIGHWOOD
State	:	IL
Zip	:	60040-1703
Country	:	US
Telephone Number	:	847-235-2139
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2021
Last Update Date	:	08/30/2022

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