Individual
DORY MICKNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2301 COURT ST, PEKIN, IL 61554-5304
(309) 308-5100
Mailing address
11550 ROPP RD, TREMONT, IL 61568-8803
(309) 202-7808
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209025883
IL
Other
Enumeration date
09/06/2022
Last updated
09/06/2022
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