Provider Demographics
NPI:1174408082
Name:RATHBUN, MAKENNA (APRN-FNP)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 MAINE ST STE 48-201
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5875
Mailing Address - Country:US
Mailing Address - Phone:217-214-6255
Mailing Address - Fax:217-277-8985
Practice Address - Street 1:4800 MAINE ST STE 48-201
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5875
Practice Address - Country:US
Practice Address - Phone:217-214-6255
Practice Address - Fax:217-277-8985
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily