Individual
CASEY AT DIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1304 BURNETT DR, TAYLORVILLE, IL 62568-9519
(217) 321-9310
Mailing address
1304 BURNETT DR, TAYLORVILLE, IL 62568-9519
(217) 321-9310
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209015986041408044
IL
Other
Enumeration date
05/15/2017
Last updated
01/13/2025
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