=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255129763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GIFTY SERWAA DANSO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 N HIGHLAND AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-966-4338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26815 ASHGATE XING
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60585-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-312-9516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 209.031517
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------