Healthcare Provider Details

I. General information

NPI: 1780060517
Provider Name (Legal Business Name): DANAE SMITH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANAE NELSON APN

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E NORRIS DR STE 2B
OTTAWA IL
61350-1611
US

IV. Provider business mailing address

420 NE GLEN OAK AVE STE 401
PEORIA IL
61603-3168
US

V. Phone/Fax

Practice location:
  • Phone: 815-431-0785
  • Fax: 815-431-0799
Mailing address:
  • Phone: 309-676-8123
  • Fax: 309-676-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277005381
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277005381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: