Individual
MRS. DENA L MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 988-6186
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085002236
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062597
—
IL
01
—
10019630
BLUE CROSS
IL
01
—
139759
HAMP
IL
01
—
3932056
BCBS
IL
01
—
7210895
AETNA
IL
01
—
894228
HEALTHLINK
IL
Enumeration date
06/28/2006
Last updated
07/21/2022
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