Healthcare Provider Details

I. General information

NPI: 1538083035
Provider Name (Legal Business Name): DANIEL MCNALLY ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST
DECATUR IL
62526-4192
US

IV. Provider business mailing address

2300 N EDWARD ST
DECATUR IL
62526-4192
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-4200
  • Fax: 217-876-4209
Mailing address:
  • Phone: 217-876-4200
  • Fax: 217-876-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.036289
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: