Provider Demographics
NPI:1114291895
Name:VAN DAM, DONNA D (APN/CNM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:D
Last Name:VAN DAM
Suffix:
Gender:F
Credentials:APN/CNM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:720 BROM CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6531
Mailing Address - Country:US
Mailing Address - Phone:630-717-9977
Mailing Address - Fax:630-717-6267
Practice Address - Street 1:720 BROM CT
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6531
Practice Address - Country:US
Practice Address - Phone:630-717-9977
Practice Address - Fax:630-717-6267
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL309.000811367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21605044OtherBLUE CROSS BLUE SHIELD