Provider Demographics
NPI:1710343314
Name:DAYOLA, ANNABELLE (APN)
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:DAYOLA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 COURT ST STE B
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4807
Mailing Address - Country:US
Mailing Address - Phone:309-349-3175
Mailing Address - Fax:309-620-8751
Practice Address - Street 1:1021 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4807
Practice Address - Country:US
Practice Address - Phone:309-349-3175
Practice Address - Fax:309-620-8751
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013321364SA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041292828OtherREGISTERED PROFESSIONAL NURSE
IL2090133221OtherAPN LICENSE NUMBER
IL309009112OtherAPN CONTROL SUBSTANCE
IL309009112OtherAPN CONTROL SUBSTANCE