Healthcare Provider Details

I. General information

NPI: 1336915677
Provider Name (Legal Business Name): DANA MCKINNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA MUCHALA

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 W STEPHENSON ST
FREEPORT IL
61032-4865
US

IV. Provider business mailing address

12138 N SPRING BROOK RD
DAVIS IL
61019-9720
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: