Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209.016876 | IL |
NPI | 1003315706 |
---|---|
Provider Name | Danielle Bryant |
First Address | Chicago, IL 60674-0001 |
Second Address | Elgin, IL 60123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2018 |
Last Update Date | 11/10/2021 |