Doctor Name: | MRS. DEANNA L. TACDERAS |
NPI Number: | 1295017663 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209009037 |
Business Practice Address: | 317 S 14th St Herrin, IL - 629483671 |
Business Phone Number: | 6189886171 |
Business Fax Number: | 6189886172 |
Mailing Address: | Po Box 1105, INDIANAPOLIS |
State: | IN |
Postal Code: | 462061105 |
Phone Number: | 6185495361 |
Fax Number: | 6185290568 |
NPI Enumeration Date: | 09/12/2011 |
NPI Last Update Date: | 02/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209009037 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |