Provider Demographics
NPI:1447479324
Name:POWERS, DANNA ELIZABETH (FNP)
Entity type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:ELIZABETH
Last Name:POWERS
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:RR 1 BOX 56
Mailing Address - Street 2:
Mailing Address - City:WAPELLA
Mailing Address - State:IL
Mailing Address - Zip Code:61777-9710
Mailing Address - Country:US
Mailing Address - Phone:217-935-6793
Mailing Address - Fax:
Practice Address - Street 1:422 W WHITE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2272
Practice Address - Country:US
Practice Address - Phone:217-937-5285
Practice Address - Fax:217-937-5296
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00626770OtherRAILROAD MEDICARE
IL209001142OtherSTAE LICENSE
ILP00954932Medicare Oscar/Certification
IL209001142OtherSTAE LICENSE
ILK51198Medicare PIN