Healthcare Provider Details

I. General information

NPI: 1306962121
Provider Name (Legal Business Name): DANIELLE KRAESSIG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE DE SAINT VICTOR CNM

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ROOSEVELT RD
BERWYN IL
60402-1108
US

IV. Provider business mailing address

6201 ROOSEVELT RD
BERWYN IL
60402-1108
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-0845
  • Fax: 708-386-8472
Mailing address:
  • Phone: 708-386-0845
  • Fax: 708-386-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-003008
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: