Healthcare Provider Details

I. General information

NPI: 1861278715
Provider Name (Legal Business Name): DANIELLE HALL APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GATEWAY DR STE 203
SYCAMORE IL
60178-3192
US

IV. Provider business mailing address

1850 GATEWAY DR STE 203
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 815-766-3942
  • Fax: 815-758-5482
Mailing address:
  • Phone: 815-766-3942
  • Fax: 815-758-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027574
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209027574
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: