Healthcare Provider Details

I. General information

NPI: 1265145965
Provider Name (Legal Business Name): ALYSON DAKER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1781
US

IV. Provider business mailing address

1742 N HONORE ST
CHICAGO IL
60622-1330
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2760
  • Fax:
Mailing address:
  • Phone: 773-418-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209026357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: