Individual
REBECKA ANNE WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5135 ROCKBERRY RD, LOVES PARK, IL 61111-3389
(608) 295-3662
Mailing address
5135 ROCKBERRY RD, LOVES PARK, IL 61111-3389
(608) 295-3662
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.109145
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043.109145
LICENSED PRACTICAL NURSE LICENSE
IL
Enumeration date
03/20/2022
Last updated
03/20/2022
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