Healthcare Provider Details

I. General information

NPI: 1326415845
Provider Name (Legal Business Name): HANNAH JO DUKEMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RICHMOND AVE E STE 3
MATTOON IL
61938-4652
US

IV. Provider business mailing address

PO BOX 372
MATTOON IL
61938-0372
US

V. Phone/Fax

Practice location:
  • Phone: 217-234-7000
  • Fax: 217-234-2060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013308
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number277-000568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: