Individual provider Active NPI

Donna J. Petko, FNP-BC

  • Family Nurse Practitioner
  • Plainfield, IL
National Provider Identifier
1023440047
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277001799 Issued in IL
Practice address
1808 Great Falls Dr
Plainfield, IL 60586-5294
Phone
(630) 768-7244
NPI assigned
Aug 1, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 277001799 IL Primary

Addresses

Primary practice location

1808 Great Falls Dr
Plainfield, IL 60586-5294

Mailing address

1808 Great Falls Dr
Plainfield, IL 60586-5294
Phone (630) 768-7244

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140520000456 IL Practitioner - Nurse Practitioner 6800019878

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1023440047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 GREAT FALLS DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605865294",
            "telephone_number": "630-768-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 GREAT FALLS DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605865294",
            "telephone_number": "630-768-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKO",
        "first_name": "DONNA",
        "middle_name": "J.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-01",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277001799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

Verify at the official NPI Registry.