Provider Demographics
NPI:1619408895
Name:DAILEY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAILEY
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 1:356 W PARK AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3049
Mailing Address - Country:US
Mailing Address - Phone:630-815-7040
Mailing Address - Fax:
Practice Address - Street 1:356 W PARK AVE
Practice Address - Street 2:APT 2
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3049
Practice Address - Country:US
Practice Address - Phone:630-815-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide