Laura Renee Dickerson, DNP, FNP-BC
Nurse Practitioner, Family in Byron, IL. Individual provider (NPI-1).
NPI number1710694401
StatusActive
Last updated in NPPESDec 27, 2023
Details
- NPI
- 1710694401
- Entity type
- Individual (NPI-1)
- Name
- Laura Renee Dickerson
- Credential
- DNP, FNP-BC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 1, 2022
- Certification date
- Dec 27, 2023
- Last updated
- Dec 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 209.026248 | IL | Yes |
| 363L00000X | Nurse Practitioner | 041.428105 | IL |
Practice location
404 W Blackhawk Dr Lowr LevelByron, IL 61010-7500
Phone 815-904-1249
Mailing address
404 W Blackhawk Dr Lowr LevelByron, IL 61010-7500
Phone 815-904-1249
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