Provider Demographics
NPI:1396855565
Name:KWONG, DANIELLE ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:KWONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:ELIZABETH
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3997
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3997
Mailing Address - Country:US
Mailing Address - Phone:815-741-2201
Mailing Address - Fax:815-741-2285
Practice Address - Street 1:310 N HAMMES AVE
Practice Address - Street 2:STE 202
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8118
Practice Address - Country:US
Practice Address - Phone:815-741-2201
Practice Address - Fax:815-741-2285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385000655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP56257Medicare UPIN
ILK13056Medicare ID - Type Unspecified