Healthcare Provider Details

I. General information

NPI: 1306086673
Provider Name (Legal Business Name): REBEKAH JANE MALONEY APN, PCNS-BC,CPON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

3835 N ASHLAND AVE APT 3N
CHICAGO IL
60613-2737
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-3815
  • Fax:
Mailing address:
  • Phone: 773-880-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041332234
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number209007418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: