Basic Information
| Provider Information | |||||||||
| NPI: | 1851051221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KARINTHOLIL | ||||||||
| FirstName: | DAYANA | ||||||||
| MiddleName: | MATHEW | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 ENGLISH OAK DR | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618223343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253295555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 819 BLOOMINGTON RD | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618202101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173561558 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2021 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | 209.024029 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
No ID Information.