Healthcare Provider Details

I. General information

NPI: 1568026375
Provider Name (Legal Business Name): REBECCA KATHERINE NATION LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S 1ST ST
CHAMPAIGN IL
61820-6916
US

IV. Provider business mailing address

1402 S 1ST ST
CHAMPAIGN IL
61820-6916
US

V. Phone/Fax

Practice location:
  • Phone: 618-610-2818
  • Fax:
Mailing address:
  • Phone: 618-610-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.005938
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000034532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: