Healthcare Provider Details

I. General information

NPI: 1225387194
Provider Name (Legal Business Name): DANIELLE MARIE EVERETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16519 S ROUTE 59
PLAINFIELD IL
60586-2607
US

IV. Provider business mailing address

609 REBECCA LN
BOLINGBROOK IL
60440-4859
US

V. Phone/Fax

Practice location:
  • Phone: 630-870-7310
  • Fax:
Mailing address:
  • Phone: 630-392-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.004210
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1831475466
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerNPI GROUP NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: