Basic Information
| Provider Information | |||||||||
| NPI: | 1730702945 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DRAGNEA | ||||||||
| FirstName: | DIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3013 SUGAR MILL CT | ||||||||
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| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624014241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035363830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 503 N MAPLE ST | ||||||||
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| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173471211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2020 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | 085008593 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.