Provider Demographics
NPI:1487705687
Name:O'SHAUGHNESSY, DARLA L (NP)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:L
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:311 W. FAIRCHILD STREET
Practice Address - Street 2:ADULT MEDICINE
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-431-7898
Practice Address - Fax:217-431-7960
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209000233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270128Medicare PIN
P29181Medicare UPIN
IL6447860014Medicare NSC