Provider Demographics
NPI:1497392948
Name:MOTLEY, DARNELL NATHANIEL (PHD)
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:NATHANIEL
Last Name:MOTLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 E 56TH ST APT 813
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1975
Mailing Address - Country:US
Mailing Address - Phone:219-689-2734
Mailing Address - Fax:
Practice Address - Street 1:1525 E 53RD ST STE 623
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4530
Practice Address - Country:US
Practice Address - Phone:219-689-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program