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General NPI Number Information
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NPI Number | 1174977482
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Entity Type | Individual
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Provider Name | DANA VIVONA RN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 155 E BRUSH HILL RD
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City | ELMHURST
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State | IL
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Zip | 60126-5658
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Country | US
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Telephone | 630-930-9280
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Fax |
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Provider Business Mailing Address
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Address Line | 224 E MADISON ST
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City | VILLA PARK
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State | IL
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Zip | 60181-3005
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Country | US
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Telephone | 630-930-9280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.014231
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License Number State | IL
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