Provider Demographics
NPI:1275994006
Name:DAILY, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DAILY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 N 1720 EAST RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE FARM
Mailing Address - State:IL
Mailing Address - Zip Code:61870-9705
Mailing Address - Country:US
Mailing Address - Phone:217-260-0783
Mailing Address - Fax:
Practice Address - Street 1:2295 N 1720 EAST RD
Practice Address - Street 2:
Practice Address - City:RIDGE FARM
Practice Address - State:IL
Practice Address - Zip Code:61870-9705
Practice Address - Country:US
Practice Address - Phone:217-260-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5005028592471C3401X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography