Healthcare Provider Details

I. General information

NPI: 1962023465
Provider Name (Legal Business Name): CATHERINE THERESA DAGIAN-STANTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HASSELL RD
HOFFMAN ESTATES IL
60169-6302
US

IV. Provider business mailing address

1209 MONARCH LN
HOFFMAN ESTATES IL
60192-1178
US

V. Phone/Fax

Practice location:
  • Phone: 847-781-4850
  • Fax: 847-781-4869
Mailing address:
  • Phone: 847-431-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041220171
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: