Individual provider · NPI-1

Dr. Laurel Ann Dettore, DNSc, MS, RN

Nurse Practitioner, Community Health · Berwyn, IL

NPI number1689929879
StatusActive
Last updated in NPPESJul 13, 2012

Details

NPI
1689929879
Entity type
Individual (NPI-1)
Name
Dr. Laurel Ann Dettore
Credential
DNSc, MS, RN
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 13, 2012
Last updated
Jul 13, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LC1500X Nurse Practitioner, Community Health214132ILYes

Practice location

6827 Stanley Ave
Berwyn, IL 60402-3287

Phone 708-795-1520 · Fax 708-795-1543

Mailing address

6827 Stanley Ave
Berwyn, IL 60402-3287

Phone 708-795-1520 · Fax 708-795-1543

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