MEDICARE: MRS. REBECCA ELIZABETH WERTH FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209010083	IL

General Provider Information

NPI Number	:	1518202076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA ELIZABETH WERTH FNP-BC

Provider Business Mailing Address
First Line	:	1132 HINSWOOD DR
Second Line	:	206
City	:	DARIEN
State	:	IL
Zip	:	60561-6440
Country	:	US
Telephone Number	:	630-417-1942
Fax Number	:	630-395-9353

Provider Business Practice Location Address
First Line	:	43W526 US HIGHWAY 30
Second Line	:
City	:	SUGAR GROVE
State	:	IL
Zip	:	60554-9511
Country	:	US
Telephone Number	:	630-466-0800
Fax Number	:	630-466-1336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	12/10/2012

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