Provider Demographics
NPI:1295592640
Name:WILKINS-TRAVIS, DANIELLE N
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:WILKINS-TRAVIS
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 1:18608 LYN CT
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3855
Mailing Address - Country:US
Mailing Address - Phone:708-400-9075
Mailing Address - Fax:
Practice Address - Street 1:18608 LYN CT
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3855
Practice Address - Country:US
Practice Address - Phone:708-400-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILW42517476871172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver