Healthcare Provider Details

I. General information

NPI: 1962092783
Provider Name (Legal Business Name): RACHEL YETTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL PORTER

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JACKSON BLVD STE 1700
CHICAGO IL
60604-3597
US

IV. Provider business mailing address

111 W JACKSON BLVD STE 1700
CHICAGO IL
60604-3597
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: