Healthcare Provider Details

I. General information

NPI: 1861140279
Provider Name (Legal Business Name): SADIE DONAGHY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SADIE LEWIS

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KISH HOSPITAL DR
DEKALB IL
60115-9602
US

IV. Provider business mailing address

1 KISH HOSPITAL DR
DEKALB IL
60115-9602
US

V. Phone/Fax

Practice location:
  • Phone: 815-766-7334
  • Fax: 815-766-9768
Mailing address:
  • Phone: 815-766-7334
  • Fax: 815-766-9768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008967
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: