Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209.014071 | IL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 209014071 | IL |
NPI | 1083076871 |
---|---|
Provider Name | Ms. Asantewah Daniels |
First Address | South Barrington, IL 60010-9533 |
Second Address | Chicago, IL 60659-3528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 27/04/2017 |