Individual
RICHARD WAYNE DANA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
605 MULBERRY ST, ROCKFORD, IL 61103-6746
(815) 720-4960
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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