Healthcare Provider Details

I. General information

NPI: 1104597491
Provider Name (Legal Business Name): PASCALE DAOU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2021
Last Update Date: 01/28/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SKOKIE BLVD STE 110
NORTHBROOK IL
60062-1614
US

IV. Provider business mailing address

40 SKOKIE BLVD STE 110
NORTHBROOK IL
60062-1614
US

V. Phone/Fax

Practice location:
  • Phone: 224-407-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024070
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: