Healthcare Provider Details

I. General information

NPI: 1366805855
Provider Name (Legal Business Name): DAN RAMOS CLEMENTE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 HIGHLAND AVE STE 200A
DOWNERS GROVE IL
60515-2100
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 844-376-3876
  • Fax: 630-929-0633
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014081
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: