Healthcare Provider Details

I. General information

NPI: 1144687625
Provider Name (Legal Business Name): DYENINA DALEON DONNELLY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DYENINA SAGUNO DALEON

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BURR RIDGE PKWY SUITE 200
BURR RIDGE IL
60527-6423
US

IV. Provider business mailing address

1333 BURR RIDGE PKWY SUITE 200
BURR RIDGE IL
60527-6423
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax: 630-832-3078
Mailing address:
  • Phone: 630-832-1775
  • Fax: 630-832-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012173
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: