Healthcare Provider Details

I. General information

NPI: 1780560839
Provider Name (Legal Business Name): DEANNA PANNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N HIGHLAND AVE
AURORA IL
60506-1449
US

IV. Provider business mailing address

218 JULEP AVE
OSWEGO IL
60543-7705
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95178035
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704390502
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017003944
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number041502608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: