| Doctor Name: | MRS. DEANNA L. RODENBERG |
| NPI Number: | 1013265248 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 2012025805 |
| Business Practice Address: | 4550 Memorial Dr Ste. 340 Belleville, IL - 622265372 |
| Business Phone Number: | 6182576200 |
| Business Fax Number: | 6182576679 |
| Mailing Address: | 4550 Memorial Dr, Ste. 340 BELLEVILLE |
| State: | IL |
| Postal Code: | 622265372 |
| Phone Number: | 6182576200 |
| Fax Number: | 6182576679 |
| NPI Enumeration Date: | 08/20/2012 |
| NPI Last Update Date: | 02/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2012025805 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |