Distinctive Dermatologyltd

NPI #1518028398 in Swansea, Illinois

Provider Information

NPI Number: 1518028398
Entity Type: Organization
Organization Name: Distinctive Dermatologyltd
Primary Specialty: Dermatology
Enumeration Date: Dec 13, 2006
Last Updated: Dec 26, 2014

Practice Location

Address: 510 FULLERTON RD
City: Swansea
State: Illinois
ZIP Code: 62226-2970
Phone: (618) 233-7666

Authorized Official

Name: MS. SUSAN L. JOURNAGAN, M.D.
Title: PRESIDENT
Phone: (618) 233-7666

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X
Dermatology	207N00000X	Primary

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