Individual
ALEXANDRIA PEBBLES VICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4215 NEWBURG RD, ROCKFORD, IL 61108-6479
(815) 988-8500
(815) 977-5956
Mailing address
4215 NEWBURG RD, ROCKFORD, IL 61108-6479
(815) 988-8500
(815) 977-5956
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.028650
IL
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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