MEDICARE: MRS. DEBRA DANIELSON-SADLICKI C.N.M., A.P.R.N.

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	176B00000X	Midwife	041191173	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041191173	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1588661961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA DANIELSON-SADLICKI C.N.M., A.P.R.N.

Provider Business Mailing Address
First Line	:	1786 MOON LAKE BLVD
Second Line	:	SUITE 207
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1067
Country	:	US
Telephone Number	:	847-884-1800
Fax Number	:	847-755-1589

Provider Business Practice Location Address
First Line	:	1786 MOON LAKE BLVD
Second Line	:	SUITE 207
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1067
Country	:	US
Telephone Number	:	847-884-1800
Fax Number	:	847-755-1589

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	11/10/2021

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