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Individual
DAWN MICHELLE DERRICK
Active
Individual
DAWN MICHELLE DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-005842
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-005842
IL STATE LIC
IL
Enumeration date
05/24/2007
Last updated
06/22/2010
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