Provider Demographics
NPI:1679229256
Name:REDDING, DANIELLE L (APRN)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:L
Last Name:REDDING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:KETCHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 E MADISON ST STE 328
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5131
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-4410
Practice Address - Street 1:747 N RUTLEDGE ST FL 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-2588
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023923363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily