Healthcare Provider Details

I. General information

NPI: 1548185689
Provider Name (Legal Business Name): BRITTANY L RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY L KAMBIC

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W REYNOLDS ST STE 103
PONTIAC IL
61764-9774
US

IV. Provider business mailing address

PO BOX 4545
CAROL STREAM IL
60197-4545
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-9491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: