Provider Demographics
NPI:1932810827
Name:MAXFIELD, DANA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:NICOLE
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:NCOLE
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:60 RAYS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-4470
Mailing Address - Country:US
Mailing Address - Phone:618-499-3075
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-922-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28153297A163W00000X
IL041303687163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse