Individual
LAURA RENEE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-BC
Contact information
Practice address
404 W BLACKHAWK DR LOWR LEVEL, BYRON, IL 61010-7500
(815) 904-1249
Mailing address
404 W BLACKHAWK DR LOWR LEVEL, BYRON, IL 61010-7500
(815) 904-1249
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
041.428105
IL
363LF0000X
Family Nurse Practitioner
Primary
209.026248
IL
Other
Enumeration date
11/01/2022
Last updated
12/27/2023
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