Healthcare Provider Details

I. General information

NPI: 1477794030
Provider Name (Legal Business Name): ANNETTE ARNOLD D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 W WINCHESTER RD SUITE 102
LIBERTYVILLE IL
60048-5341
US

IV. Provider business mailing address

34219 N BLUESTEM RD
ROUND LAKE IL
60073-5245
US

V. Phone/Fax

Practice location:
  • Phone: 224-558-8508
  • Fax:
Mailing address:
  • Phone: 224-558-8508
  • Fax: 847-740-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181.000352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: