Individual
MRS. DEANNA L. RODENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4550 MEMORIAL DR, STE. 340, BELLEVILLE, IL 62226-5372
(618) 257-6200
(618) 257-6679
Mailing address
4550 MEMORIAL DR, STE. 340, BELLEVILLE, IL 62226-5372
(618) 257-6200
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041404382
IL
363L00000X
Nurse Practitioner
Primary
209009887
IL
363LF0000X
Family Nurse Practitioner
2012025805
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041404382
RN
IL
01
—
209009887
APN
IL
Enumeration date
08/20/2012
Last updated
02/08/2014
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