Provider Demographics
NPI:1588661961
Name:DANIELSON-SADLICKI, DEBRA (CNM, APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:DANIELSON-SADLICKI
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 MOON LAKE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1067
Mailing Address - Country:US
Mailing Address - Phone:847-884-1800
Mailing Address - Fax:847-755-1589
Practice Address - Street 1:1786 MOON LAKE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1067
Practice Address - Country:US
Practice Address - Phone:847-884-1800
Practice Address - Fax:847-755-1589
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041191173176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041191173OtherSTATE LICENSE