Healthcare Provider Details

I. General information

NPI: 1033905872
Provider Name (Legal Business Name): MAYA DONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13909 S BUDLER RD
PLAINFIELD IL
60544-2460
US

IV. Provider business mailing address

2S500 IROQUOIS CT W
WARRENVILLE IL
60555-2111
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: