Healthcare Provider Details

I. General information

NPI: 1700395381
Provider Name (Legal Business Name): DANIELLE LEIGH WESNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DANIELLE LEIGH DUMELE

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 36TH AVE
MOLINE IL
61265-7127
US

IV. Provider business mailing address

1100 36TH AVE
MOLINE IL
61265-7127
US

V. Phone/Fax

Practice location:
  • Phone: 309-743-6700
  • Fax: 309-764-2042
Mailing address:
  • Phone: 309-743-6700
  • Fax: 309-764-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA131758
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number041.407490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: