Individual
MS. TAMMY DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3004 GRAND AVE, WAUKEGAN, IL 60085-2321
(401) 602-3938
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209028247
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437494630
—
CT
05
—
1437494630
—
RI
Enumeration date
11/29/2012
Last updated
03/05/2024
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