Healthcare Provider Details

I. General information

NPI: 1073532511
Provider Name (Legal Business Name): NANCY GAYLE DAGEFOERDE NP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY GAYLE HALBERSTADT NP, APN

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 ROXBURY ROAD
ROCKFORD IL
61107-5059
US

IV. Provider business mailing address

PO BOX 6003
ROCKFORD IL
61126-6003
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-3000
  • Fax: 815-398-3041
Mailing address:
  • Phone: 815-398-3000
  • Fax: 815-391-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209002451
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: