Provider Demographics
NPI:1285273144
Name:KNOX, DANA R (PMHNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:KNOX
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 N 3000TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:IL
Mailing Address - Zip Code:62351-2510
Mailing Address - Country:US
Mailing Address - Phone:217-440-6211
Mailing Address - Fax:
Practice Address - Street 1:1076 N 3000TH AVE
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:IL
Practice Address - Zip Code:62351-2510
Practice Address - Country:US
Practice Address - Phone:217-440-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041384624363LP0808X
IL277001814363LP0808X
IL209020603363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health