Healthcare Provider Details

I. General information

NPI: 1861500043
Provider Name (Legal Business Name): DEBRA JO HEPBURN MS RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-5737
  • Fax:
Mailing address:
  • Phone: 217-554-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: