Healthcare Provider Details

I. General information

NPI: 1528913019
Provider Name (Legal Business Name): REBEKKAH SUE GORS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 N ALPINE RD
LOVES PARK IL
61111-3107
US

IV. Provider business mailing address

428 2ND ST
STILLMAN VALLEY IL
61084-8991
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209034880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: