Healthcare Provider Details

I. General information

NPI: 1679119945
Provider Name (Legal Business Name): REBECCA JUNE ANSTEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S B B KING BLVD
MEMPHIS TN
38103-9801
US

IV. Provider business mailing address

940 W GLENLAKE AVE UNIT 35D
CHICAGO IL
60660-5908
US

V. Phone/Fax

Practice location:
  • Phone: 773-620-1936
  • Fax:
Mailing address:
  • Phone: 773-620-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number277.003794
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA182884
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.003794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: