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General NPI Number Information
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NPI Number | 1609414119
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Entity Type | Individual
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Provider Name | LAURA ANNE RECOB FNP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 7180 SPRING BROOK RD
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City | ROCKFORD
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State | IL
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Zip | 61114-6700
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Country | US
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Telephone | 815-971-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 5607 WYNMERE DR
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City | SOUTH BELOIT
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State | IL
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Zip | 61080-9214
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Country | US
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Telephone | 630-951-9511
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.018995
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License Number State | IL
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