Provider Demographics
NPI:1154856060
Name:DALY, ELLEN M (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:DALY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 OGDEN AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7205
Mailing Address - Country:US
Mailing Address - Phone:630-585-0200
Mailing Address - Fax:
Practice Address - Street 1:2040 OGDEN AVE STE 115
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7205
Practice Address - Country:US
Practice Address - Phone:630-585-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007358363A00000X, 363A00000X
MI5601008177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical