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General NPI Number Information
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NPI Number | 1013265248
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Entity Type | Individual
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Provider Name | DEANNA L. RODENBERG NP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 02/08/2014
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Provider Practice Location Address
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Address Line | 4550 MEMORIAL DR STE. 340
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City | BELLEVILLE
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State | IL
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Zip | 62226-5372
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Country | US
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Telephone | 618-257-6200
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Fax | 618-257-6679
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Provider Business Mailing Address
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Address Line | 4550 MEMORIAL DR STE. 340
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City | BELLEVILLE
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State | IL
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Zip | 62226-5372
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Country | US
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Telephone | 618-257-6200
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Fax | 618-257-6679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2012025805
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041404382
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209009887
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License Number State | IL
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