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General NPI Number Information
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NPI Number | 1073624664
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Entity Type | Individual
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Provider Name | REBECCA F NISHIMOTO PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 777 PARK AVE W
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2433
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Country | US
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Telephone | 847-926-5844
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 N RIDGE BLVD UNIT 4H
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City | CHICAGO
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State | IL
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Zip | 60645-2056
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Country | US
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Telephone | 773-499-8180
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 085002085
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002085
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License Number State | IL
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