Provider Demographics
NPI:1164060257
Name:DANIELS, JULIE ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:5808 W EDDY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4351
Mailing Address - Country:US
Mailing Address - Phone:312-623-2303
Mailing Address - Fax:
Practice Address - Street 1:5808 W EDDY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4351
Practice Address - Country:US
Practice Address - Phone:312-623-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020377363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner