Healthcare Provider Details

I. General information

NPI: 1669492203
Provider Name (Legal Business Name): DONALD R. SCHMIDGALL RNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-3000
  • Fax: 217-554-4195
Mailing address:
  • Phone: 217-554-3000
  • Fax: 217-554-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number484033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: