Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209007872 | IL |
NPI | 1053648063 |
---|---|
Provider Name | Danielle E Siedschlag |
First Address | Freeport, IL 61032-4008 |
Second Address | Freeport, IL 61032-3801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2009 |
Last Update Date | 26/10/2017 |