Rebecca L Coolidge, CPM, LM
Individual provider Active NPI Midwife · Island Lake, IL
NPI 1891242855 · NPPES record last updated Sep 7, 2016
Key facts
- NPI
- 1891242855
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- 210-49 (WI)
- Practice address
- 3506 Oakwood Dr
Island Lake, IL 60042-9207 - Phone
- (847) 363-5811
- NPI assigned
- Sep 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210-49 | WI | MD | Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Authentic Midwives LLC | Midwife | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | 210-49 | WI | Yes |
Addresses
Primary practice location
3506 Oakwood Dr
Island Lake, IL 60042-9207
Mailing address
3506 Oakwood Dr
Island Lake, IL 60042-9207
Phone (847) 363-5811
Other providers in Island Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.