Laurel Ann Dettore, DNSC, MS, RN

Primary specialty

Community Health Nurse PractitionerTaxonomy code 363LC1500X

License

214132 Issued in IL

Practice address

6827 Stanley Ave
Berwyn, IL 60402-3287

Phone

(708) 795-1520

Fax

(708) 795-1543

NPI assigned

Jul 13, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1689929879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6827 STANLEY AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023287",
            "telephone_number": "708-795-1520",
            "fax_number": "708-795-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6827 STANLEY AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023287",
            "telephone_number": "708-795-1520",
            "fax_number": "708-795-1543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTORE",
        "first_name": "LAUREL",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DNSC, MS, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "IL",
            "license": "214132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Subodh C Desai, MD
• Ana Luisa Desantiago, LCSW
• Michelle L. Desideri-Sojka, M.A., L.C.P.C.
• Cassie Desir, LSW
• Nejat Destani, M.D.
• Michael Sean Dewolfe, M.D.
• Antoinette M Dezzutti, LISW, LCSW
• Nathan Kim Dhablania, MD, MPH, MS
• Tilak R Dhingra, DC
• Diabetic Supply Center

• Community Health Nurse Practitioner in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Community Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.