Healthcare Provider Details

I. General information

NPI: 1639401409
Provider Name (Legal Business Name): DANIELLE LANDGREBE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W CARPENTER ST
SPRINGFIELD IL
62702-4902
US

IV. Provider business mailing address

350 W CARPENTER ST
SPRINGFIELD IL
62702-4902
US

V. Phone/Fax

Practice location:
  • Phone: 217-525-0210
  • Fax:
Mailing address:
  • Phone: 217-525-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number041306211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: