MEDICARE: DETONYA ARMSTRONG 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277002344	IL
2	363LF0000X	Family Nurse Practitioner	277002344	IL
3	363LF0000X	Family Nurse Practitioner	209.016912	IL

General Provider Information

NPI Number	:	1346754835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DETONYA ARMSTRONG FNP

Provider Business Mailing Address
First Line	:	8556 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4709
Country	:	US
Telephone Number	:	708-973-8071
Fax Number	:	620-205-4129

Provider Business Practice Location Address
First Line	:	8556 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4709
Country	:	US
Telephone Number	:	708-973-8071
Fax Number	:	620-205-4129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	03/08/2026

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