Healthcare Provider Details

I. General information

NPI: 1720678261
Provider Name (Legal Business Name): SALIE DAVILA TORRES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 WARRENVILLE RD STE 301
LISLE IL
60532-4317
US

IV. Provider business mailing address

20 W KINZIE ST
CHICAGO IL
60654-6392
US

V. Phone/Fax

Practice location:
  • Phone: 312-776-2432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021635
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: