Provider Demographics
NPI:1851051221
Name:KARINTHOLIL, DAYANA MATHEW (NP)
Entity type:Individual
Prefix:
First Name:DAYANA
Middle Name:MATHEW
Last Name:KARINTHOLIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 ENGLISH OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3343
Mailing Address - Country:US
Mailing Address - Phone:425-329-5555
Mailing Address - Fax:
Practice Address - Street 1:109 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3909
Practice Address - Country:US
Practice Address - Phone:217-366-5180
Practice Address - Fax:217-366-5185
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024029363LC1500X
IL209024029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty