Provider Demographics
NPI:1649384686
Name:DICIRO, DOROTHEA U (APN, CS)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHEA
Middle Name:U
Last Name:DICIRO
Suffix:
Gender:F
Credentials:APN, CS
Other - Prefix:MISS
Other - First Name:DOROTHEA
Other - Middle Name:U
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2499
Mailing Address - Country:US
Mailing Address - Phone:618-395-5222
Mailing Address - Fax:618-395-8552
Practice Address - Street 1:1200 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2499
Practice Address - Country:US
Practice Address - Phone:618-395-5222
Practice Address - Fax:618-395-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180726OtherHEALTHLINK
IL068530OtherHEALTH ALLIANCE
IL180726OtherHEALTHLINK
IL210225Medicare ID - Type Unspecified