MEDICARE: MS. DANIELLE HANNIGAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.008190	IL

General Provider Information

NPI Number	:	1417257247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE HANNIGAN APN

Provider Business Mailing Address
First Line	:	4802 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4233
Country	:	US
Telephone Number	:	773-376-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	04/22/2022

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