Provider Demographics
NPI:1881669760
Name:DUDA, CONNIE A (CFNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:A
Last Name:DUDA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1401
Mailing Address - Country:US
Mailing Address - Phone:217-732-9681
Mailing Address - Fax:217-735-6527
Practice Address - Street 1:515 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1401
Practice Address - Country:US
Practice Address - Phone:217-732-9681
Practice Address - Fax:217-735-6527
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-253531OtherRN LICENSE
IL041-253531OtherRN LICENSE
P36016Medicare UPIN