Healthcare Provider Details

I. General information

NPI: 1376299933
Provider Name (Legal Business Name): EMMANUEL BENTIL OFORI DANSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 COMPTON DR
HUNTLEY IL
60142-2344
US

IV. Provider business mailing address

1603 N ORCHARD ST APT 108
CHICAGO IL
60614-5491
US

V. Phone/Fax

Practice location:
  • Phone: 773-759-7390
  • Fax:
Mailing address:
  • Phone: 773-759-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209024826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: