Provider Demographics
NPI:1841996469
Name:DRYFHOUT, DANISE LOUISE (APN, FNP-C, RN)
Entity type:Individual
Prefix:
First Name:DANISE
Middle Name:LOUISE
Last Name:DRYFHOUT
Suffix:
Gender:F
Credentials:APN, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2717
Mailing Address - Country:US
Mailing Address - Phone:815-434-1977
Mailing Address - Fax:815-434-2022
Practice Address - Street 1:645 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2717
Practice Address - Country:US
Practice Address - Phone:815-434-1977
Practice Address - Fax:815-434-2022
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.400162163W00000X
IL209.027130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.027130OtherSTATE OF ILLINOIS