Healthcare Provider Details

I. General information

NPI: 1144266578
Provider Name (Legal Business Name): RACHEL L COLBY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL L ROBINSON

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W US ROUTE 6
MORRIS IL
60450-4200
US

IV. Provider business mailing address

725 SCHOOL ST STE A
MORRIS IL
60450-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-4875
  • Fax:
Mailing address:
  • Phone: 815-705-1405
  • Fax: 815-794-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1782
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085003446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: