Provider Demographics
NPI:1366807927
Name:PEBELSKE, ANN (APN CNS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PEBELSKE
Suffix:
Gender:F
Credentials:APN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6432 MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1329
Mailing Address - Country:US
Mailing Address - Phone:630-969-6804
Mailing Address - Fax:
Practice Address - Street 1:6432 MAXWELL DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1329
Practice Address - Country:US
Practice Address - Phone:630-969-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.170433163W00000X
IL209.013667364SA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology