Individual
DOROTHY J LOOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
900 S DEER RD, MACOMB, IL 61455-2639
(309) 837-4876
Mailing address
11510 N 950TH RD, MACOMB, IL 61455-7972
(309) 833-5354
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
041.113213
IL
163WP0808X
Psychiatric/Mental Health Registered Nurse
041.113213
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.113213
RN LICENSE
IL
01
—
370984175
BWAY INC FEIN
IL
Enumeration date
04/13/2007
Last updated
04/14/2009
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