Healthcare Provider Details

I. General information

NPI: 1720124258
Provider Name (Legal Business Name): TANYA A DURRER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 N ILLINOIS ROUTE 3
WATERLOO IL
62298-1000
US

IV. Provider business mailing address

618 MARK DR
WATERLOO IL
62298-1487
US

V. Phone/Fax

Practice location:
  • Phone: 618-939-4444
  • Fax: 618-939-4181
Mailing address:
  • Phone: 618-939-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: