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General NPI Number Information
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NPI Number | 1629491535
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Entity Type | Individual
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Provider Name | DANIELLE SPARACINO
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Gender | Female
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1890 SILVER CROSS BLVD SUITE 210
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City | NEW LENOX
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State | IL
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Zip | 60451-0000
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Country | US
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Telephone | 815-463-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 19830 FOXBOROUGH DR
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City | MOKENA
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State | IL
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Zip | 60448-1890
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Country | US
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Telephone | 708-878-3985
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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 | 209011055
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License Number State | IL
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