Healthcare Provider Details

I. General information

NPI: 1720202369
Provider Name (Legal Business Name): REBECCA SUE PENDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E EUCLID AVE
MONMOUTH IL
61462-1247
US

IV. Provider business mailing address

1007 230TH ST
ALEDO IL
61231-8533
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-9461
  • Fax: 309-734-3909
Mailing address:
  • Phone: 309-582-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number077683
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041.246874
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041.246874
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: