Healthcare Provider Details

I. General information

NPI: 1982182424
Provider Name (Legal Business Name): NICOLE MARIE DALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 09/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 RANDALL RD
GENEVA IL
60134-4200
US

IV. Provider business mailing address

304 RANDALL RD
GENEVA IL
60134-4200
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-0610
  • Fax:
Mailing address:
  • Phone: 630-232-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018222
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: