Healthcare Provider Details

I. General information

NPI: 1396398012
Provider Name (Legal Business Name): DANIELA DOYLE MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

711 FOREST AVE
RIVER FOREST IL
60305-1750
US

V. Phone/Fax

Practice location:
  • Phone: 773-203-1009
  • Fax:
Mailing address:
  • Phone: 773-203-1009
  • Fax: 312-227-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209017756
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.017756
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: