Healthcare Provider Details

I. General information

NPI: 1811302409
Provider Name (Legal Business Name): RENEE J DAHM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 09/29/2026
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax: 815-971-9162
Mailing address:
  • Phone: 815-971-2000
  • Fax: 815-971-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-011916
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-328608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: