Healthcare Provider Details

I. General information

NPI: 1710347893
Provider Name (Legal Business Name): RACHAEL WHITNEY VILLARREAL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL WHITNEY MARKS APN

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 N ILLINOIS ST
FAIRVIEW HEIGHTS IL
62208
US

IV. Provider business mailing address

1475 KISKER RD
SAINT CHARLES MO
63304-8781
US

V. Phone/Fax

Practice location:
  • Phone: 314-687-2734
  • Fax:
Mailing address:
  • Phone: 366-498-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014435
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.014435
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016005846
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016005846
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: