Healthcare Provider Details

I. General information

NPI: 1043778772
Provider Name (Legal Business Name): RHONDA J GALE APN-NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHONDA J LAMB

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

IV. Provider business mailing address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-6500
  • Fax:
Mailing address:
  • Phone: 815-971-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209018979
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: