Provider Demographics
NPI:1346754835
Name:ARMSTRONG, DETONYA (FNP)
Entity Type:Individual
Prefix:
First Name:DETONYA
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3410
Mailing Address - Country:US
Mailing Address - Phone:087-239-2150
Mailing Address - Fax:
Practice Address - Street 1:14701 PULASKI RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3410
Practice Address - Country:US
Practice Address - Phone:087-239-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016912363LF0000X
IL277002344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily