Individual
MRS. DEANNA L. TACDERAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
317 S 14TH ST, HERRIN, IL 62948-3671
(618) 988-6171
(618) 988-6172
Mailing address
PO BOX 1105, INDIANAPOLIS, IN 46206-1105
(618) 549-5361
(618) 529-0568
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209009037
IL
Other
Enumeration date
09/12/2011
Last updated
02/25/2015
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