Provider Demographics
NPI:1821406257
Name:DALY, CARRIE (APN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S YORK ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5634
Mailing Address - Country:US
Mailing Address - Phone:331-221-5678
Mailing Address - Fax:331-221-2706
Practice Address - Street 1:420 W BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4980
Practice Address - Country:US
Practice Address - Phone:630-310-6505
Practice Address - Fax:331-221-2706
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL421533176001Medicaid