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NPI Code Detail

MEDICARE: MS. DAWN MARIE VANDERMEER FNP

MEDICARE: MS. DAWN MARIE VANDERMEER FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse28169646AIN
2163W00000XRegistered Nurse041358938IL
3363LF0000XFamily Nurse Practitioner71008641AIN
4363LF0000XFamily Nurse Practitioner209018520IL

General Provider Information

NPI Number : 1124502224
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DAWN MARIE VANDERMEER FNP
Provider Business Mailing Address
First Line : 9551 171ST ST
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-6109
Country : US
Telephone Number : 708-873-0062
Fax Number :
Provider Business Practice Location Address
First Line : 9551 171ST ST
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-6109
Country : US
Telephone Number : 708-873-0062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2018
Last Update Date : 10/22/2020

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