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General NPI Number Information
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NPI Number | 1902598832
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Entity Type | Individual
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Provider Name | DEENA GRACE MICHAEL APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 539 S SPRING RD
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City | ELMHURST
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State | IL
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Zip | 60126-3824
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Country | US
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Telephone | 847-400-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 BRANDON RD
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City | GLENVIEW
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State | IL
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Zip | 60025-2336
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Country | US
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Telephone | 847-990-0119
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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 | 209027494
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License Number State | IL
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