Healthcare Provider Details

I. General information

NPI: 1710343314
Provider Name (Legal Business Name): ANNABELLE DAYOLA-LEDFORD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E MAIN ST
KNOXVILLE IL
61448-1330
US

IV. Provider business mailing address

8303 HOPEDALE RD
HOPEDALE IL
61747-9672
US

V. Phone/Fax

Practice location:
  • Phone: 309-349-3175
  • Fax: 309-620-8751
Mailing address:
  • Phone: 309-363-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209013321
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number277000014
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209013321
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: