Individual
MS. DANA MARIE RUHOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
900 W TEMPLE AVE STE 208, EFFINGHAM, IL 62401-2187
(618) 332-0953
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.420849
IL
363L00000X
Nurse Practitioner
209.031383
IL
363LF0000X
Family Nurse Practitioner
Primary
209031383
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.420849
REGISTERED PROFESSIONAL NURSE LICENSE
IL
01
—
209.031383
ADVANCE PRACTICE REGISTERED NURSE LICENSE
IL
Enumeration date
01/09/2025
Last updated
06/12/2025
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