Healthcare Provider Details

I. General information

NPI: 1417077785
Provider Name (Legal Business Name): REBECCA L PIND APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

422 COOK AVE
JONESBORO IL
62952-1100
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-2295
  • Fax: 618-833-9058
Mailing address:
  • Phone: 618-833-5161
  • Fax: 618-833-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: