Healthcare Provider Details

I. General information

NPI: 1538150107
Provider Name (Legal Business Name): DANNEILLE C TRUJILLO-HANSEN APRNBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANNEILLE C HANSEN APRNBC

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 SIOUX DR
MARION IL
62959-5209
US

IV. Provider business mailing address

109 CALIFORNIA ST
CARTERVILLE IL
62918-1923
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5270
  • Fax: 618-997-5029
Mailing address:
  • Phone: 618-985-8221
  • Fax: 618-985-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number041223102
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number209004760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: