Doctor Name: | DANIELLE PRAY |
NPI Number: | 1972989838 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 209012992 |
Business Practice Address: | 100 W 15th St Beardstown, IL - 626181774 |
Business Phone Number: | 2173222245 |
Business Fax Number: | 2173239362 |
Mailing Address: | 238 S Congress St, RUSHVILLE |
State: | IL |
Postal Code: | 626811465 |
Phone Number: | 2173224321 |
Fax Number: | 2173226459 |
NPI Enumeration Date: | 08/03/2015 |
NPI Last Update Date: | 08/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209012992 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |