Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 209.018951 | IL |
NPI | 1003389503 |
---|---|
Provider Name | Mrs. Edita Aurelia Danaiata |
First Address | Sterling, IL 61081-1279 |
Second Address | Aurora, IL 60504-4510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2019 |
Last Update Date | 19/07/2021 |