Provider Demographics
NPI:1881292019
Name:YEDNOCK, DANA BETH (DNP, WHNP-BC, APRN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:BETH
Last Name:YEDNOCK
Suffix:
Gender:F
Credentials:DNP, WHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2535
Mailing Address - Country:US
Mailing Address - Phone:815-822-5647
Mailing Address - Fax:
Practice Address - Street 1:1444 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2535
Practice Address - Country:US
Practice Address - Phone:815-822-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022080363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health