Healthcare Provider Details

I. General information

NPI: 1588068464
Provider Name (Legal Business Name): REBECCA J MERCHIORI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA HARRISTHAL

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N EAST ST
OLNEY IL
62450-6927
US

IV. Provider business mailing address

1400 LEMAY FERRY RD
SAINT LOUIS MO
63125-2408
US

V. Phone/Fax

Practice location:
  • Phone: 618-395-5222
  • Fax: 618-395-8552
Mailing address:
  • Phone: 314-776-7999
  • Fax: 314-772-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209012066
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number309.007726
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309.007726
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2017035715
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021003533
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: