MEDICARE: DANIELLE SPARACINO

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	209011055	IL

General Provider Information

NPI Number	:	1629491535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE SPARACINO

Provider Business Mailing Address
First Line	:	19830 FOXBOROUGH DR
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-1890
Country	:	US
Telephone Number	:	708-878-3985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 SILVER CROSS BLVD
Second Line	:	SUITE 210
City	:	NEW LENOX
State	:	IL
Zip	:	60451-0000
Country	:	US
Telephone Number	:	815-463-3000
Fax Number	:

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

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	08/05/2024

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Directions to “ DANIELLE SPARACINO ” Practice Location

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