Deaconess Clinc Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

DEACONESS CLINC INC

Doing business as

Deaconess Clinic - At Work Marion

Practice address

3329 W Deyoung St
Marion, IL 62959-5884

Phone

(812) 450-6966

NPI assigned

Feb 23, 2024

Last updated

Feb 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cheryl Annette Wathen

Title

Cfo

Phone

(812) 450-3296

Specialties & licenses 2

Addresses

Other names 1

• Deaconess Clinic - At Work Marion Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Deaconess Clinic Inc101 organizations share this tax ID, including this one

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

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1295591634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631767",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3329 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595884",
            "telephone_number": "812-450-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS CLINC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Clinic - At Work Marion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel Dawkins, LCSW
• Amanda K Dawson, RN
• Amanda Jo Day, RN
• Shobha Dayal, MD
• Jeffery S Deacon, DPM
• Deaconess Illinois Clinic, Inc
• Deaconess Illinois Clinic, Inc (Deaconess IL Clinic 17th St)
• Deaconess Illinois Clinic, Inc (Deaconess Illinois Clinic)
• Deaconess Illinois Clinic, Inc (Deaconess IL Clinic 2700 DeYoung)
• Deaconess Illinois Clinic, Inc (Deaconess IL Clinic 3329 DeYoung)

• Nurse Practitioner in Marion, IL
• Providers in Marion, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.