Provider Demographics
NPI:1942767280
Name:WETZEL, DANIELLE R (APN DPN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:WETZEL
Suffix:
Gender:F
Credentials:APN DPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 OGDEN AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7205
Mailing Address - Country:US
Mailing Address - Phone:630-375-2844
Mailing Address - Fax:630-375-2808
Practice Address - Street 1:2040 OGDEN AVE STE 215
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7205
Practice Address - Country:US
Practice Address - Phone:630-375-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019168363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics