MEDICARE: DANIELLE SOLARES DNP, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209022410	IL

General Provider Information

NPI Number	:	1013509660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE SOLARES DNP, FNP-C

Provider Business Mailing Address
First Line	:	5333 JACKIES CT
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-3446
Country	:	US
Telephone Number	:	815-494-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 COLONY BAY DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-2560
Country	:	US
Telephone Number	:	779-368-0757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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