Provider Demographics
NPI:1659063121
Name:DAYRIES, BROOKE ODELIA (APN NP)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ODELIA
Last Name:DAYRIES
Suffix:
Gender:F
Credentials:APN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-1444
Mailing Address - Country:US
Mailing Address - Phone:847-757-0668
Mailing Address - Fax:
Practice Address - Street 1:2037 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-1444
Practice Address - Country:US
Practice Address - Phone:847-757-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily