Healthcare Provider Details

I. General information

NPI: 1144270471
Provider Name (Legal Business Name): DENICE D STUDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W WALNUT ST
METAMORA IL
61548-8637
US

IV. Provider business mailing address

901 W WALNUT ST
METAMORA IL
61548-8637
US

V. Phone/Fax

Practice location:
  • Phone: 325-348-3566
  • Fax: 325-348-3791
Mailing address:
  • Phone: 309-367-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number695222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: