Healthcare Provider Details

I. General information

NPI: 1407715824
Provider Name (Legal Business Name): JULIET DIMAYUGA TECSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE STE LL
NORMAL IL
61761-6506
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-2920
  • Fax: 309-268-2929
Mailing address:
  • Phone: 217-383-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: