Provider Demographics
NPI:1477392058
Name:SMITH, DANIELLE LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 W ARMY TRAIL ROAD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9368
Mailing Address - Country:US
Mailing Address - Phone:630-517-5674
Mailing Address - Fax:630-300-3702
Practice Address - Street 1:270 W ARMY TRAIL ROAD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9368
Practice Address - Country:US
Practice Address - Phone:630-517-5674
Practice Address - Fax:630-300-3702
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029753363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily