Healthcare Provider Details

I. General information

NPI: 1689918336
Provider Name (Legal Business Name): REBECCA PLUTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

IV. Provider business mailing address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

V. Phone/Fax

Practice location:
  • Phone: 630-352-5450
  • Fax: 630-352-5320
Mailing address:
  • Phone: 630-352-5450
  • Fax: 630-352-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004568
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10001469A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: