Healthcare Provider Details

I. General information

NPI: 1740286103
Provider Name (Legal Business Name): TONYA DARR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N EDWARDSVILLE ST
STAUNTON IL
62088-1334
US

IV. Provider business mailing address

444 N EDWARDSVILLE ST
STAUNTON IL
62088-1334
US

V. Phone/Fax

Practice location:
  • Phone: 618-635-3800
  • Fax: 619-635-3952
Mailing address:
  • Phone: 618-635-3800
  • Fax: 618-635-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209003565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: