Individual
DANA J. DESHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
435 MAXINE DR, MORTON, IL 61550-2498
(309) 263-2424
(309) 284-2255
Mailing address
435 MAXINE DR, MORTON, IL 61550-2498
(309) 263-2424
(309) 284-2255
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041270005/209000621
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840030
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
10/19/2006
Last updated
06/10/2010
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