Provider Demographics
NPI:1710343314
Name:DAYOLA-LEDFORD, ANNABELLE (APN)
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:DAYOLA-LEDFORD
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 HOPEDALE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-9672
Mailing Address - Country:US
Mailing Address - Phone:309-363-1047
Mailing Address - Fax:
Practice Address - Street 1:415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IL
Practice Address - Zip Code:61448-1330
Practice Address - Country:US
Practice Address - Phone:309-349-3175
Practice Address - Fax:309-620-8751
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013321364SA2200X, 363L00000X
IL277000014364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309009112OtherAPN CONTROL SUBSTANCE
IL041292828OtherREGISTERED PROFESSIONAL NURSE
IL2090133221OtherAPN LICENSE NUMBER
IL309009112OtherAPN CONTROL SUBSTANCE