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General NPI Number Information
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NPI Number | 1770044711
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Entity Type | Individual
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Provider Name | JESSICA DANIEL NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/30/2019
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Last Update Date | 07/28/2019
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE # MC-2026
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 773-702-3794
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Fax |
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Provider Business Mailing Address
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Address Line | 7026 WILSON TER
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City | MORTON GROVE
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State | IL
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Zip | 60053-1236
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Country | US
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Telephone | 773-592-3096
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209018583
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License Number State | IL
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