Individual
ALIVIA RENEA DERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3375 N SEMINARY ST, GALESBURG, IL 61401-1251
(309) 343-5114
(309) 343-7859
Mailing address
3375 N SEMINARY ST, GALESBURG, IL 61401-1251
(309) 343-5114
(309) 343-7859
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017147
IL
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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