Basic Information
| Provider Information | |||||||||
| NPI: | 1619140316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAYE | ||||||||
| FirstName: | MONA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAYE | ||||||||
| OtherFirstName: | MONA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | APN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1401 LAKEWOOD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604503352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159426323 | ||||||||
| FaxNumber: | 8159426423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 LAKEWOOD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604503352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159426323 | ||||||||
| FaxNumber: | 8159426423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 12/21/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0807X | 209.006997 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | 041-272589 | 01 | IL | RN | OTHER | 209.006997 | 01 | IL | APN | OTHER |