Healthcare Provider Details

I. General information

NPI: 1114126364
Provider Name (Legal Business Name): REBECCA JANE BYLER DANN M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ILLINI DR # 1649
PEORIA IL
61605-2576
US

IV. Provider business mailing address

1 ILLINI DR # 1649
PEORIA IL
61605-2576
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-3024
  • Fax: 309-655-3739
Mailing address:
  • Phone: 309-655-3024
  • Fax: 309-655-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD429275
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: