Provider Demographics
NPI:1093159832
Name:ROSS, DANIEL (APN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E ERIE ST
Mailing Address - Street 2:SUITE 709
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2926
Mailing Address - Country:US
Mailing Address - Phone:847-769-2687
Mailing Address - Fax:847-325-0917
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 709
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:847-769-2687
Practice Address - Fax:847-325-0917
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010380363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health