Provider Demographics
NPI:1679343727
Name:DAVIS, DANIELLE N
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:DAVIS
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 1:7211 S YATES BLVD APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2572
Mailing Address - Country:US
Mailing Address - Phone:773-648-3276
Mailing Address - Fax:
Practice Address - Street 1:7211 S YATES BLVD APT 1B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2572
Practice Address - Country:US
Practice Address - Phone:773-648-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver