Healthcare Provider Details

I. General information

NPI: 1346529245
Provider Name (Legal Business Name): DARA LEE MCKINLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST
EVANSTON IL
60201-1777
US

IV. Provider business mailing address

2650 RIDGE AVE # 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1029
  • Fax:
Mailing address:
  • Phone: 847-982-3362
  • Fax: 530-899-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030822
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP20830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: