Individual
MRS. LAURA L DAGDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
650 DAKOTA ST STE A, CRYSTAL LAKE, IL 60012-3744
(815) 455-6000
(815) 356-1104
Mailing address
650 DAKOTA ST STE A, CRYSTAL LAKE, IL 60012-3744
(815) 338-6600
(815) 356-1104
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209009741
IL
363LF0000X
Family Nurse Practitioner
Primary
209009741
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209009741
STATE LICENSE
IL
Enumeration date
08/17/2012
Last updated
12/19/2018
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