Laura Renee Dickerson, DNP, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Byron, IL
NPI 1710694401 · NPPES record last updated Dec 27, 2023
Key facts
- NPI
- 1710694401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.026248 (IL)
- Practice address
- 404 W Blackhawk Dr Lowr Level
Byron, IL 61010-7500 - Phone
- (815) 904-1249
- NPI assigned
- Nov 1, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041.428105 | IL | MD | Nurse Practitioner |
| 209.026248 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrative Medical Associates of Rockford, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 041.428105 | IL | |
| Family Nurse Practitioner | 363LF0000X | 209.026248 | IL | Yes |
Addresses
Primary practice location
404 W Blackhawk Dr Lowr Level
Byron, IL 61010-7500
Mailing address
404 W Blackhawk Dr Lowr Level
Byron, IL 61010-7500
Phone (815) 904-1249
Other providers in Byron, IL
- Rachel Eleanor Bridges
- Wendy Bulthuis-Susong
- Jeremy Buttram
- Byron Cusd 226
- Byron Fire Protection District
- Jenifer Elizabeth Druien
- Eats and Speaks
- Grace Elaine Edwards
- Eyecare Dimensions LLC
- Felker Pharmacy Inc
All providers in Byron, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.