Healthcare Provider Details

I. General information

NPI: 1124404736
Provider Name (Legal Business Name): LORILEE DUNAHEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S 1ST ST
FAIRBURY IL
61739-1509
US

IV. Provider business mailing address

106 S 1ST ST
FAIRBURY IL
61739-1509
US

V. Phone/Fax

Practice location:
  • Phone: 815-692-2833
  • Fax: 815-692-3278
Mailing address:
  • Phone: 815-692-2833
  • Fax: 815-692-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041259267
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: