Healthcare Provider Details

I. General information

NPI: 1023222304
Provider Name (Legal Business Name): NANCY A DEYOUNG APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S DIXIE HWY
BEECHER IL
60401-3668
US

IV. Provider business mailing address

715 S DIXIE HWY
BEECHER IL
60401-3668
US

V. Phone/Fax

Practice location:
  • Phone: 708-946-9330
  • Fax:
Mailing address:
  • Phone: 708-946-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: