Healthcare Provider Details

I. General information

NPI: 1730071788
Provider Name (Legal Business Name): DANIELA ECHEVERRI IDROBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WALL ST STE C100
KANKAKEE IL
60901-2942
US

IV. Provider business mailing address

389 PRINCETON AVE
BOURBONNAIS IL
60914-1163
US

V. Phone/Fax

Practice location:
  • Phone: 844-404-4787
  • Fax:
Mailing address:
  • Phone: 815-216-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: